Sung-hoon Jung

Carpal Tunnel Syndrome Caused by Space Occupying Lesions

Purpose To evaluate the diagnosis and treatment of the carpal tunnel syndrome (CTS) due to space occupying lesions (SOL). Materials and Methods Eleven patients and 12 cases that underwent surgery for CTS due to SOL were studied retrospectively. We excluded SOL caused by bony lesions, such as malunion of distal radius fracture, volar lunate dislocation, etc. The average age was 51 years. There were 3 men and 8 women. Follow-up period was 12 to 40 months with an average of 18 months. The diagnosis of CTS was made clinically and electrophysiologically. In patients with swelling or tenderness on the area of wrist flexion creases, magnetic resonance imaging (MRI) and/or computed tomogram (CT) were additionally taken as well as the carpal tunnel view. We performed conventional open transverse carpal ligament release and removal of SOL. Results The types of lesion confirmed by pathologic examination were; tuberculosis tenosynovitis in 3 cases, nonspecific tenosynovitis in 2 cases, and gout in one case. Other SOLs were tumorous condition in five cases, and abnormal palmaris longus hypertrophy in 1 case. Tumorous conditions were due to calcifying mass in 4 cases and ganglion in 1 case. Following surgery, all cases showed alleviation of symptom without recurrence or complications. Conclusion In cases with swelling or tenderness on the area of wrist flexion creases, it is important to obtain a carpal tunnel view, and MRI and/or CT should be supplemented in order to rule out SOLs around the carpal tunnel, if necessary.

Correction of lumbosacral hyperlordosis in achondroplasia.

Anterior bulging of the abdomen and posterior protrusion of the buttocks are externally visible deformities reflecting lumbosacral hyperlordosis. Imbalance in pelvic femoral muscles may account for this posture. Despite the clinical significance of hyperlordosis, its surgical treatment has not been well-described. In the current preliminary study, the authors compare two techniques used at the authors’ institution for lower limb lengthening, one of which affects the correction of lumbosacral hyperlordosis. Ten patients had bilateral lower extremity lengthening procedures. Seven patients had bilateral tibial lengthening and three patients had combined femoral and tibial lengthening. Ring external fixators were used. Correction of hyperlordosis was assessed by comparing four radiographs with measurements in the sagittal plane obtained preoperatively with those at the latest followup. In the femoral lengthening group, the average preoperative lumbar lordosis angle was 18°, the lumbosacral joint angle was 12°, the sacral inclination angle was 58.3°, and the sacrohorizontal angle was 31°. The mean changes at the latest followup were: lumbar lordosis angle (+1°), lumbosacral joint angle (+0.3°), sacral inclination angle (−19°), and sacrohorizontal angle (−15°). In the tibia lengthening group, all parameters were relatively unaltered at the last followup compared with their preoperative levels. Tibial lengthening had no effect on lumbosacral hyperlordosis. However, femoral lengthening resulted in an improved apparent lumbosacral hyperlordosis, although the lumbar lordosis angle was not changed significantly. The change in sacrum tilting provides a likely explanation for the improvement in cosmetic hyperlordosis observed in patients who have had femoral lengthening.

Obstructive sleep apnea in postmenopausal women: a comparative study using drug induced sleep endoscopy

INTRODUCTION The key to successful treatment of OSAS is to individually tailor such treatment. Thus, it is very important to determine the severity of OSAS, its pattern, and the extent of collapse, by gender, age, and BMI. OBJECTIVE The objective of the study was to understand the characteristics of obstructive sleep apnea in postmenopausal women by comparing postmenopausal and premenopausal subjects, and men, using DISE. We hope that our work will help the medical community to consult on, diagnose, and treat OSAS more effectively. METHODS A total of 273 patients (195 males and 78 females) diagnosed with OSAS were enrolled. Female patients were divided into pre-menopausal (n=41) and post-menopausal patients (n=37). The group of post-menopausal female patients was matched with a group of male patients with similar age and body mass index (BMI). DISE findings were compared between pre-menopausal female patients and post-menopausal female patients, and also between post-menopausal female patients and male patients matched for age and BMI. RESULTS Upon PSG examination, post-menopausal patients (who had a significantly higher BMI than did pre-menopausal patients; 25.6kg/m2 vs. 23.5kg/m2; p=0.019) tended to have a higher AHI and a lower lowest SaO2, but the differences did not attain statistical significance. With DISE analysis, post-menopausal female patients showed higher values in all obstruction sites, with significantly higher value in lateral diameter of retropalatal (1.49 vs. 0.90; p=0.001) and retrolingual levels (1.14 vs. 0.61; p=0.003) compared to pre-menopausal females patients. Post-menopausal female patients showed significantly more retrolingual collapse (antero-posterior, AP, p≤0.0001, and lateral diameter, p=0.042) in the lower BMI group (BMI<25) and more concentric retropalatal collapse (lateral diameter, p=0.017 and tonsillar obstruction, p=0.003) in higher BMI group (BMI≥25) than BMI and age matched male patients. CONCLUSION Post-menopausal female patients showed a different pattern of airway obstruction compared to pre-menopausal female patients and male patients matched for age and BMI based on DISE findings.

The incidence of concha bullosa, unusual anatomic variation and its relationship to nasal septal deviation: A retrospective radiologic study ☆

OBJECTIVE Identifying anatomical variations associated with pathological findings is very useful for diagnoses and therapeutics. We conducted a study to detect various anatomical variations (superior, middle, inferior turbinate concha bullosa, uncinate bulla and nasal swell body [NSB]) in connection with nasal septal deviation. METHODS This study used a retrospective radiological design to analyze 594 (1188 sides) osteomeatal computed tomography scans from 494 male patients and 100 female patients aged between 17 and 75 years. We randomly selected 100 male and 100 female patients as controls; we compared the groups and performed a statistical analysis. All patients in the control group had sinusitis only (i.e., they lacked nasal septal deviations). RESULTS Left-sided septal deviation was found to be slightly more prevalent than right-sided deviation (43.9% and 36.4%, respectively). The incidence of S-curved septal deviation was 18.5%, that of dorso-ventral deviation was 10.9%, and that of caudal-rostral deviation was 7.6%. The incidence of only septal spur was 1.2%. In the case of middle turbinate concha bullosa, the incidence of the unilateral type was 17.3% and that of the bilateral type was 36.4%. In superior turbinate concha bullosa, the incidence of the unilateral type was 11.3% and that of the bilateral type was 27.4%. The incidence of inferior turbinate concha bullosa was 1.0% and that of uncinate bulla was 1.7%. NSB was found in 25.1% of patients, 24.7% of males and 27.0% of females. The frequencies of middle and superior concha bullosa were about 10-12 fold higher on the concave side. The nasal septal deviation group exhibited a higher incidence of most anatomical variants than the non-deviated group; differences in the middle turbinate concha bullosa attained statistical significance. CONCLUSION The radiologist must focus on anatomical variants in the preoperative evaluation. It is important for surgeons to be aware of these variations.

Effect of a Facial Muscle Exercise Device on Facial Rejuvenation

Abstract Background The efficacy of facial muscle exercises (FMEs) for facial rejuvenation is controversial. In the majority of previous studies, nonquantitative assessment tools were used to assess the benefits of FMEs. Objectives This study examined the effectiveness of FMEs using a Pao (MTG, Nagoya, Japan) device to quantify facial rejuvenation. Methods Fifty females were asked to perform FMEs using a Pao device for 30 seconds twice a day for 8 weeks. Facial muscle thickness and cross-sectional area were measured sonographically. Facial surface distance, surface area, and volumes were determined using a laser scanning system before and after FME. Facial muscle thickness, cross-sectional area, midfacial surface distances, jawline surface distance, and lower facial surface area and volume were compared bilaterally before and after FME using a paired Student t test. Results The cross-sectional areas of the zygomaticus major and digastric muscles increased significantly (right: P < 0.001, left: P = 0.015), while the midfacial surface distances in the middle (right: P = 0.005, left: P = 0.047) and lower (right: P = 0.028, left: P = 0.019) planes as well as the jawline surface distances (right: P = 0.004, left: P = 0.003) decreased significantly after FME using the Pao device. The lower facial surface areas (right: P = 0.005, left: P = 0.006) and volumes (right: P = 0.001, left: P = 0.002) were also significantly reduced after FME using the Pao device. Conclusions FME using the Pao device can increase facial muscle thickness and cross-sectional area, thus contributing to facial rejuvenation. Level of Evidence: 4

Correlation between toe flexor strength and ankle dorsiflexion ROM during the countermovement jump

[Purpose] This study assessed the relationships between peak toe flexor muscle strength, ankle dorsiflexion range of motion, and countermovement jump height. [Subjects and Methods] Eighteen healthy volunteers participated in the study. Each participant completed tests for peak toe flexor muscle strength, ankle dorsiflexion range of motion, and countermovement jump height. [Results] The results showed (1) a moderate correlation between ankle dorsiflexion range of motion and countermovement jump height and (2) a high correlation between peak first toe flexor muscle strength and countermovement jump height. Peak first toe flexor muscle strength and ankle dorsiflexion range of motion are the main contributors to countermovement jump performance. [Conclusion] These findings indicate that the measurement of peak first toe flexor muscle strength and ankle dorsiflexion range of motion may be useful in clinical practice for improving jump performance in athletes training for sports such as volleyball and basketball.

Effect of applying consistent pressure to the stationary and the moving arm on measurement reliability of glenohumeral internal rotation range of motion

ABSTRACT Objectives: The aim of this study was to determine the inter-rater reliability of glenohumeral internal rotation (GIR) range of motion (ROM) and pressure measurements among four measurement methods: (1) Manual stabilization of the humeral head and coracoid process (MSHC) without applying consistent pressure (ACP) to both the stationary and the moving arms (BSaMA); (2) MSHC with ACP to the moving arm; (3) MSHC with ACP to the stationary arm; and (4) MSHC with ACP to BSaMA. Design: Test-retest analyses. Participants: 39 subjects with GIR deficit. Main outcome measures: GIR ROM and pressure were measured on the stationary or moving arm by four examiners using the Clinometer application and a pressure biofeedback unit. Results: GIR ROM measurement with MSHC and ACP to the moving arm resulted in the lowest intra-class correlation coefficient (ICC = .43); the ICC for MSHC without ACP to BSaMA was .54; that for MSHC with ACP to the stationary arm was .77; and that for MSHC with ACP to BSaMA was highest, at .81. Conclusion: MSHC with ACP to both arms leads to reliable GIR ROM measurement in a clinical setting.

Reliability and criterion validity of measurements using a smart phone-based measurement tool for the transverse rotation angle of the pelvis during single-leg lifting

ABSTRACT Objective: The purposes of this study were to determine the intra-rater test–retest reliability of a smart phone-based measurement tool (SBMT) and a three-dimensional (3D) motion analysis system for measuring the transverse rotation angle of the pelvis during single-leg lifting (SLL) and the criterion validity of the transverse rotation angle of the pelvis measurement using SBMT compared with a 3D motion analysis system (3DMAS). Method: Seventeen healthy volunteers performed SLL with their dominant leg without bending the knee until they reached a target placed 20 cm above the table. This study used a 3DMAS, considered the gold standard, to measure the transverse rotation angle of the pelvis to assess the criterion validity of the SBMT measurement. Intra-rater test–retest reliability was determined using the SBMT and 3DMAS using intra-class correlation coefficient (ICC) [3,1] values. The criterion validity of the SBMT was assessed with ICC [3,1] values. Result: Both the 3DMAS (ICC = 0.77) and SBMT (ICC = 0.83) showed excellent intra-rater test–retest reliability in the measurement of the transverse rotation angle of the pelvis during SLL in a supine position. Moreover, the SBMT showed an excellent correlation with the 3DMAS (ICC = 0.99). Conclusion: Measurement of the transverse rotation angle of the pelvis using the SBMT showed excellent reliability and criterion validity compared with the 3DMAS.

Comparison of Hip and Back Muscle Activity and Pelvic Compensation in Healthy Subjects During Three Different Prone Table Hip Extension Exercises

CONTEXT Prone hip extension has been recommended for strengthening the back and hip muscles. Previous studies have investigated prone hip extension conducted with subjects on the floor in the prone position. However, no study has compared 3 different table hip-extension (THE) positions in terms of the activities of the back- and hip-joint muscles with lumbopelvic motion. OBJECTIVE To identify more effective exercises for strengthening the gluteus maximus (GM) by comparing 3 different exercises (THE alone, THE with the abdominal drawing-in maneuver [THEA], and THEA with chair support under the knee [THEAC]) based on electromyographic muscle activity and pelvic compensation. DESIGN Repeated-measure within-subject intervention. SETTING University research laboratory. PARTICIPANTS 16 healthy men. MAIN OUTCOME MEASURES Surface electromyography (EMG) was used to obtain data on the GM, erector spinae (ES), multifidus, biceps femoris (BF), and semitendinosus (ST). Pelvic compensation was monitored using an electromagnetic motion-tracking device. Exertion during each exercise was recorded. Any significant difference in electromyographic muscle activity and pelvic motion among the 3 conditions (THE vs THEA vs THEAC) was assessed using a 1-way repeated-measures analysis of variance (ANOVA) with Bonferroni post hoc test. RESULTS The muscle activities recorded by EMG differed significantly among the 3 exercises (P < .01). GM activity was increased significantly during THEAC (P < .01). There was a significant difference in lumbopelvic kinematics in terms of anterior tilting (F = 19.49, P < .01) and rotation (F= 27.38, P < .01) among the 3 exercises. CONCLUSIONS The THEAC exercise was the most effective for strengthening the GM without overactivity of the ES, BF, and ST muscles and lumbopelvic compensation compared with THE and THEA.

Effects of horizontal shoulder abduction and adduction on the activity and strength of the scapular protractors

Increased activity of the serratus anterior (SA) muscle combined with decreased activity of the pectoralis major (PM) muscle during scapular protraction exercise is a widely used method for selective strengthening of the former muscle. However, the role played by the PM during maximal scapular protraction remains unclear. The objective of our study was to investigate the effects of horizontal shoulder abduction (decreasing PM activity) and adduction (increasing activity) on the strength and activity of the scapular protractors (the SA and PM) during maximal protraction. Twenty-nine healthy males performed maximal scapular protraction combined with horizontal shoulder abduction or adduction. The strength and activity of the PM and SA decreased significantly (both p < 0.01) during maximal scapular protraction combined with horizontal shoulder abduction, compared with maximal scapular protraction alone, but increased significantly (both p < 0.01) when maximal scapular protraction was combined with horizontal shoulder adduction. We thus conclude that the PM stabilizes the activated SA during maximal scapular protraction, which effectively increases SA activity and scapular protraction strength in the serratus punch posture.