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多田 秀穂, 松井 猛, 前田 道宣, 高橋 秀人
1986 年 10 巻 1 号 p.
1-4
発行日: 1986/07/28
公開日: 2012/11/20
ジャーナル
フリー
The purpose of this paper is to clarify the blood vessel arrangement of a human rotator cuff of the shoulder.
Method: Six shoulders of four fresh cadavers were harvested to this study. Four of six shoulders were those of the newborn, and two shoulders were those of 56 years old female. one was normal, the other had degenerative change in the rotator cuff. After injection of the diluted Indian ink-Latex solution through a subclavian artery, the specimen was fixed with formalin. Dissection was followed to observe the vascular distribution of a rotator cuff. The cuff was then removed to be dehydrated in ethanol and cleared in mixture of trycrecyl phosphate and tri-n-butyl phosphate. The specimen was photographed by transillumination to observe fine vessels. Histological examination of a rotator cuff was also done.
Result: 1) At the area near the insertion of a rotator cuff into the humerus, fine vessels were recognized. These fine vessels seemed to be anastomoses between the branches of the anterior and posterior circumflex humeral arteries ascending proximally through the surface of a humerus to the rotator cuff, and branches of the supraspinatus, thoracoacromial and subscapular arteries running distally in the rotator cuff.
2) Much vascular distribution was seen in the supraspinatus tendon of the newborn. In the aged, no avascular area was recognized in the normal supraspinatus tendon, but less vascularized area was seen in the degenerative supraspinatus tendon.
3) The infraspinatus and teres minor tendons were well vascularized of both the newborn and the aged.
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尾崎 二郎, 藤本 誠, 藤木 淳一郎, 冨田 恭治, 仲川 喜之, 増原 建二
1986 年 10 巻 1 号 p.
5-8
発行日: 1986/07/28
公開日: 2012/11/20
ジャーナル
フリー
Many authors have descrived the pathological changes and the treatment of the unstable shoulder and the contracted shoulder, however, the function of coracohumeral ligament and the rotator interval has not been emphasized. This paper is to descrive a significant role of coracohumeral ligament and rotator interval in relation to the pathogenesis and the surgical treatment of the unstable shoulder and the contracted shoulder. The coracohumeral ligament originates in the outer border of the horizontal limb of the coracoid process and passes forward and downward in the interval between the supraspinatus and infraspinatus muscles. Sixteen patients with contracted shoulder, which has been resistant against our ordinary conservative treatments, were treated surgically in our clinic. The pathological changes were found mainly at the coracohumeral ligament and rotator interval. Histologically, the contracted coracohumeral ligament and freezed rotator interval were consisted of fibrosis. Otherwise, seven patients with the unstable shoulder were operated, and detachment or elongation of coracohumeral ligament and the break in the rotator interval were found in these cases. Therefore, the coracohumeral ligament and the rotator interval are the very important components on the rotator cuff. It is concluded that this point is one of the locus minoris resistantiae of the shoulder joint.
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宮原 寿明, 高岸 憲二, 杉岡 洋一, 大屋 国益
1986 年 10 巻 1 号 p.
9-11
発行日: 1986/07/28
公開日: 2012/11/20
ジャーナル
フリー
The course of the repair of the rotator cuff rupture has not been fully clarified experimentally in comparison with that of other tendons such as flexor tendon and Achilles tendon. The purpose of this study is to deliniate the repair of the canine rotator cuff rupture histologically in two instances; 1) only resection of the rotator cuff tendon and 2) tendon to bone repair after cuff resection.
24 adult mongrel dogs (12-17kg) were used. The study was divided into two groups: group I. Only resection of the rotator cuff; rotator cuff was resected 15 mm in width and 10 mm in length. Group II. Tendon to bone repair after cuff resection; the stump of the cuff was anchored into the trough cut at the greater tuberosity. After operation, a plaster cast was applied for 3 weeks. Dogs were killed at regular intervals and specimens including the cuff and the greater tuberosity were obtained. These were fixed, decalcified, embedded in paraffin, sectioned and stained with hematoxylin and eosin and with Azan-Mallory.
The gross and micro s copic changes were investigated. Group I. after 1 week, scar tissue formation was present, but not completely, at the gap between the proximal stump and the greater tuberosity. After 6 weeks, the gap was completely filled with scar tissue. However, microscopically, orientation of fibers was at random with many proliferating blood vessels and invasion of inflammatory cells. Group II. After 2 weeks, orientation of the fibers were at random with proliferations of blood vessels and fibroblasts. At the tendo-osseous junction, proliferation of cartilage tissue was noted. After 24 weeks, orientation of collagen fibers and appearance of tendo-osseous junction were similar to those seen in normal rotator cuff.
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朝長 匡, 伊藤 信之, 常岡 武久
1986 年 10 巻 1 号 p.
12-16
発行日: 1986/07/28
公開日: 2012/11/20
ジャーナル
フリー
The shoulder joints and their connecting muscles participate in cooperation in the wide, smooth and expedient movements of the arm, which was once described by Codman so aptly as “ scapulohumeral rhythm” . And, there are numerous analysis of the mechanism studies. The present study was undertaken to establish a more reliable quantitative method for comprehending the dynamics of the electromyographic activity in relation to the measurement of elevation angles during the flexion, scapular abduction and abdution movement of the shoulder.
Materials and Methods;
Twenty shoulder of ten n ormal male students were the subjects of study.70 microns fine wire electrodes were assigned to the trapezius (upper fider), supraspinatus, deltoideus (asterior, middle and posterior fiber), pectralis major (clavicular head), latissimus dorsi, teres major and rhomboideus muscles. Examinees were asked to elevate their arm in each direction with or without the 2.6 kg load at their hands. The electromyograms and elevation angle obtained by the goniometer were recorded by using a magnetic tape data recorder simultaneously. The computer was used for integrating the action potentials from examined muscles at 10 degrees intervals of elevation angle. And, the percentage of integrated action potential in each examinee and each direction was analyzed to observe muscle activies.
Results;
The perc e ntages of integrated action potentials from the trapezius (upper fiber), supraspinatus, deltoideus (anterior and middle fiber), pectralis major (clavicular head) and rhomboideus muscles showed high and increased with the increasing magnitude of elevation angle. Though the anterior, middle and posterior fiber of deltoideus muscle were the same muscle, the difference of integrated action potential pattern in those fibers was observed. On the electromyogram, the action potential from the anterior fiber of deltoid was observed prior to that from middle fiber in flexion, but in abduction that pattern was reversed. The deltoideus (posterior fiber), latissimus dorsi and teres major muscles showed low percentage of integrated action potential.
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中川 照彦, 石田 明允, 高橋 誠, 森脇 正之, 古屋 光太郎, 荒井 孝和, 石突 正文, 武田 修一
1986 年 10 巻 1 号 p.
17-21
発行日: 1986/07/28
公開日: 2012/11/20
ジャーナル
フリー
We produced the apparatus for measuring the motion of the shoulder joint in order to analyse the shoulder movement quatitativety and three dimentionally. This apparatus has a gimbal which has two degrees of freedom and a telescoping tube which has one degree of freedom. Two angles of rotation of a gimbal and a tube displacement are detected by optical rotary encoder. The personal computer takes on these signals through the counter.
A subject's trunk is held by standing fram e and his arm is placed on a straight posterior elbow splint. The L shaped bar is attached to the posterior elbow splint and protrudes from it. The tip of the bar is connected with the end of the tube. When the subject moves his arm, the locus of the end of the tube is projected in the horizontal plane, the sagittal plane and the coronal plane. These projection are displayed on the monitor TV and the data are stored in diskets. The personal computer calculates the range of motion of the shoulder.
Furthermore, we made the program for measu r ing the maximum area of motion of the shoulder. If a subject moves his arm, the path of motion lies on a sphere of which center correspods to the shoulder joint. The maximum area of motion is indicated by the percentage of the whole spherical surface.32 narmal shoulders were analysed. The mean percentage was 50 %.
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村上 元庸, 牧川 方昭, 前野 幹幸, 畑 正樹, 七川 歓次
1986 年 10 巻 1 号 p.
22-24
発行日: 1986/07/28
公開日: 2012/11/20
ジャーナル
フリー
When abducting the arm, the scapula and the humerus move cooperatively. This cooperation is known as “scapulohumeral rhythm”, and a constant relationship is said to exist between the abduction angle of the humerus and that of the scapula.
But since the glenoid is too small to support the humeral head, it may happen that the humeral head will be dislocated or the soft tissue, like tendons or capsule, will be exposed to a excessive load, if the resultant force through the humeral head does not directly face to the glenoid. So we guess that a change of the resultant force which is consist of load and muscle power to the humerus may change the incline of the glenoid even at the same humeral abducting angle.
In this study, we investigated the relationship between the glenoid inclination angle and the humeral abduction angle with or without block of the supraspinatus muscle power by the suprascapular nerve block.
The subjects of this experiment was 5 healthy men, and the angle was measured by X-ray films which were taken at every 45 degrees abduction position with voluntary effort to abduct isometrically before and after the nerve block, and also the abduction torque was measured simultaneously by the Cybex- II.
The result was that the inclination angle of the scapula was decreased after block, as the maximum defference at 90 degree abduction by 6 degree. And the torque was decreased by the mean of 25 %.
From our hypothesis that the resultant force faces the glenoid perpendicularly, these results could be explained by the functional anatomy of the supraspinatus tendon. At 0 and 135 degree abduction the supraspinatus runs perpendicularly to the glenoid, so the resultant force does not change the direction after block. But at 90 degree abduction the position of the insertion of the supraspinatus is the highest of all abduction angle, so it acts to pull down the head. The resultant that force after block changes the direction upward, and so the glenoid inclination angle decreases to face the head.
From these results, we guess a resultant force to the humeral head always faces to the glenoid by controlled constraction of the muscles around the shoulder.
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池田 均, 寺岡 亨, 塚西 茂昭, 信原 克哉
1986 年 10 巻 1 号 p.
25-29
発行日: 1986/07/28
公開日: 2012/11/20
ジャーナル
フリー
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近藤 司, 長岡 徳三, 伊藤 信之
1986 年 10 巻 1 号 p.
30-32
発行日: 1986/07/28
公開日: 2012/11/20
ジャーナル
フリー
The treatment of the acromioclavicular dislocation has been, and it still, controversal. The patients whose dislocations of A-C joints are not reduced often complain discomfort and fatigue on the affected side. This study is to attempt to evaluate objectively fatigue on the affected side by analysis of tracking movement of the arm, and electromyographical change of the shoulder girdle muscles.
Method and Materials
The patients w ho had type II dislocation of the A-C joint have been investigated on the sound and affected sides. They were asked to move their shoulder in accordance with sine curves pictured on the oscilloscope, with range from 1 to 4 Hz. The directions of movement were flexion and scapular abduction, and each movement was started from 0 and 90 elevation. The electromyograms of shoulder girdle muscles and the angle of the tracking movement were recorded to a data recorder. Surface electrodes were assigned to the trapezius (upper fiber), rhomboid, deltoid and pectralis major muscles. The activity pattern of each muscle and frequency response of the shoulder movements on the both sides were investigated. Results
The sound side moved more accuratly than the affected side during the 4 Hz stimulation. Amplitude of the linear envelope of trapezius and rhomboid muscles on the affected side was higher than that on the sound side. This study of the tracking movement suggests that the fatigue on the dislocated side is due to the increase of action potential of these muscles.
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宮崎 誠一, 水野 耕作, 生田 進一, 山本 哲司
1986 年 10 巻 1 号 p.
33-35
発行日: 1986/07/28
公開日: 2012/11/20
ジャーナル
フリー
A comparative study was done between range of motion and arthrography in 58 patients with so-called 50 kata. And muscle strength analysis on shoulder girdle was done by Cybex II dynamometer.
According to grade of contraction, shape of pooling shadow of inferior fold classified into four types. And shape of posterior joint space classified into three types. In patients of so-called 50 kata, pooling shadow of inferior fold was smaller than the other disease of the shoulder.
According to multiregression analysis, pooling shadow of inferior fold w as in relation to range of abduction and flexion on so-called 50 kata. Posterior joint space slightly related with the other motion except flexion. Pooling shadow of inferior fold was contributed by flexion, abduction, and external rotation, especially Flexion. Posterior joint space was slightly contributed by the other motion except flexion.
Cybex II dynamomenter revealed that the patients with so-called 50 kata attained less strength to strength healthy site in endurance. Especially strength of abduction was injuried.
On conclusion, it is intimate ralation between contraction of inferior fold a nd decrease of range of flexion on so-called 50 kata. And weakness of strength of abduction is remarkable on so-called 50 kata. So, on so-called 50 kata, it is necessary, increasing range of flexion and strength of abduction.
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柴田 陽三, 竹下 満, 高岸 直人
1986 年 10 巻 1 号 p.
36-40
発行日: 1986/07/28
公開日: 2012/11/20
ジャーナル
フリー
Intra-articular pressure (1-A pressure) of the gleno-humeral joint (G-H Joint) was measured in order to elucidate the mechanism of shoulder joint. (Material and Method)
Ten normal subjects were measured. Fluidfilled teflon tube, with two small perforations around tip, was inserted into the axillary pouch from anterior aspect of the shoulder joint. The end of tube was connected to a pressure transducer. Intra-articular pressure was measured during movement of the shoulder joint when subjects were sitting position.
(Result) When none of saline was injected into the gleno-humeral joint, there was almost no change of intar-articular pressure. But, when 10 ml and 20 ml of saline were injected into G-H joint, I-A pressure rose at shoulder elevation. I-A pressure with 20 ml of saline was higher and rose more steeply at the same elevated position. It was demonstrated that 1-A pressure was highest at full elevation. The relationship of I-A pressure and joint position before and after full elevation demonstrated that the pressures were lower than for the same joint position before full elevation.
There were peak pressures at the full internal rotated position and the full externa l rotated position, but latter was higher than the former. The lowest value of I-A pressure was showed at the slightly flexed, abducted and internal rotated position.
And further measurements were done in the disease joints.
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岡本 仁志, 福田 宏明, 持田 譲治, 寺田 洋
1986 年 10 巻 1 号 p.
41-45
発行日: 1986/07/28
公開日: 2012/11/20
ジャーナル
フリー
Diagnosis for the subacromial impingement syndrome (S. I. S. ) including rotator cuff tears has been made by clinical signs and shoulder arthrography. However, some lesions in S. I. S. may not be identified with even arthrography and subacromial bursography. Recently, a few reports on the use of ultrasonorraphy (U. S. ) for S. I. S. has been found.
We have also performed U. S. for the S. I. S. preo p eratively and occasionally at operation. Based on our experience, indication and limitation of U. S. are discussed.
Material: 21 operated cases were evaluated: 5 in G rade I (subacromial bursitis and/or tendinitis),7 in Grade II (partial thickness cuff tear) and 9 in Grade III (full thickness cuff tear). There were 17 men and 4 women, whose ages ranged from 25 to 70 (mean 49).
Method: We used a real time ultrasound scanner (Hitachi EUB-40) and 7.5 MHz transducer with water bag and “Kitecko”(polymer gel).
Examination was performed in t he sitting position on bilateral supraspinatus tendons in both longitudinal and transverse planes.
Subsequently, dynamic s t u dies were also done by rotating the arm in the anatomical position. Following U. S., pathology was reconfirmed by surgery in all cases.
Result: U. S. findings are summerized as follows: In Grade I, the rotator cuff was thicker than that of normal side. In Grade II, irregularity was found in the sites of bursal side tear and rim rent. No findings have been obtained suggesting intratendinous tear in this series. In Grade III, heterogene'Ous and high level echogenicity and cuff defects were observed.
Conclusion: 1 U. S. is non-invasive and can be applied for the diagnosis of S. I. S. When combined with shoulder arthrography and subacromial bursography, the diagnostic accuracy is incresed.2 U. S. is a dynamic examination requiring multiphasic observations.3 U. S. is probably best, indicated for the intratendinous tears of the rotator cuff and intratendinous extensions of the partial thickness tears.4 In contrast to the clear visualization of cuff defects on the sonogram in most cases, interpretations may be subtle occasionally.
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黒川 正夫, 榊田 喜三郎, 山下 文治
1986 年 10 巻 1 号 p.
46-48
発行日: 1986/07/28
公開日: 2012/11/20
ジャーナル
フリー
We have been using ultrasonography for diagnosing deseases of the rotator cuff due to its easy procedure and lack of invasiveness, and found it useful to detect morphological changes.
Three shoulders with incomplete cuff tear,10 with complete tear,10 with mas s ive tear,11 with cuff tendinitis,5 with calcific cuff tendinitis,2 with fracture of the greater tberosity as well as 67normal shoulders were examined by ultrasonography.
Yokokawa ultrasonographer (U- sonic RT-2000) using linear scan in the B mode at 3.5 MHz. Debubbled water was placed between the transducer and skin. The examinee was placed in the Fowler's position, and the shoulder was examined by the internal rotation with the arm at the side of the body. The measurments were made in two directions, the transducer being placed in the fiber direction of the supraspinatus muscle and at the right angles to the supraspinatus muscle.
The cuff of the normal group had the same echogenesity as that of the muscles in the controls, and a low homogenous echogenesity. Thickness of the normal cuff layer (distance between subacromial bursa and humeral head was measured as thickness of the cuff layer) was 6.21±1.05 mm.
Many of the patients with cuff tear showed irregular and high echogenesity, and irreg u lar superficial layer. Thickness of the cuff layer was 5.67±1.25 mm in the incomplete tear,4.50±1.12 mm in the complete tear, and 2.25±0.43 mm in the massive tear, the degree and site of the cuff tear thus being estimated from the thickness of the cuff layer.
The findings for the cuff tendinitis were not c learly different from those of the normal group, but in calcific cuff tendinitis high echogenic calcium deposite were clearly visualized in islandspots in the cuff.
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黒田 重史, 住吉 徹是, 蔡 永南
1986 年 10 巻 1 号 p.
49-53
発行日: 1986/07/28
公開日: 2012/11/20
ジャーナル
フリー
Although CT examination or CT arthrographic examination is not able to take the place of conventional arthrography, in some cases such as so-called loose shoulder, habitual dislocation and rotator cuff tear, more accurate details can be obtained using CT pictures.
From June 1981 to June 1985,158 CT examinations (143 cases) and 114 CT arthrographic examinations (114 cases) of shoulder joints were performed and investigated at KASHIMA ROSAI HOSPITAL and MATSUDO ORTHOPAEDIC HOSPITAL.
They were taken in 30 degrees semilateral p osition on the affected side. The palm was put on the abdomen. To avoid the artifact from the opposite shoulder and jaw, the affected shoulder girdle was elevated and the neck was extended.
The scanning conditions were as follows: 120 KV,200 mA, scanning time was 11.52 seconds, window width was 1000 and window level was 50. Before CT arthrography, about 15 ml of 7.6 %urografin was injected intra-articularly. In some cases of CT arthrographic examination additional scans were taken in elevated position of the shoulder joint.
The posterior opening angle of the gleno-humeral joint had a close corelationship with a grade of the loosening of the shoulder joint. In the cases of so-called loose shoulders (44 joints in 30 cases), it was 24.3±0.9. In the loosening cases in only internally rotated position (33 joints in 32 cases) it was 17.2±0.8. In control cases, which were stable in any position (81 joints in 81 cases) it was 12.3±0.4. The application of a “t” test yielded a P value of 0.01 for the difference between each of the two groups. It was a conclusive factor for the diagnosis and the choice of surgical methods. They were reported in details at Japan Shoulder Society in 1983 and 1984.
CT arthrographic examination was particularly useful for diagnosis of habitual dislocation, “Rotator interval” lesion, dislocation of the long head of biceps muscle and rotator cuff tear.
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広岡 淳, 米田 稔, 脇谷 滋之
1986 年 10 巻 1 号 p.
54-57
発行日: 1986/07/28
公開日: 2012/11/20
ジャーナル
フリー
Various kinds of radiological examinations for the fine diagnosis of the anterior shoulder instability have been done, but they do not catch all lesions the soft and bony lesions.
In our clinic, computed arthrotomography (CAT) has been used to make the lesions clearer. In this study, the usefulness of CAT for the diagnosis of anterior shoulder instability was discussed.
17 patients with anterior shoulder instability confirmed the lesions intraoperatively,13 males and 4 females, aged 15.5 to 45.5-years (mean age 25.4) at operation, were studied. CAT was done using low density-single contrast method. Contrast medium (3-4 % urographine,15-20 cc) was injected into the bilateral shoulder joints from anterior part, immediatly, CT scanning of both shoulders and elbows was done. The following findings were evaluated; enlargement of anterior glenoidal recess meaning the laxity of anterior capsule, osseous and cartilaginous Bank art lesion, and Hill-Sachs defect. For these findings, the diagnostic yield of CAT compared with that of arthrogram. Moreover, glenoid tilt angle and humeral torsion were measured from CAT films.
On the diagnostic yield of the Bankart lesion, CAT was more excellent than arthrogram.
Even a small detachment of glenoid labrum observed on arthroscopy using probing technique, could be detected by bilateral CAT. Hill-Sachs defects were found on CAT in all cases, however, erosive changes of the posterolateral portion of humeral head were not. For the enlargement of anterior glenoidal recess, the diagnostic yield of CAT was similar to that of arthrogram.
Although CAT was the excellent diagnostic tool of anterior shoulder instability, it was essential for the further accurate diagnosis that it was carried out bilaterally.
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杉本 良洋, 中土 幸男, 斉藤 覚, 杉浦 憲治, 八木 了
1986 年 10 巻 1 号 p.
58-62
発行日: 1986/07/28
公開日: 2012/11/20
ジャーナル
フリー
We report the case of a patient with entrapment of the suprascapular nerve by a small ganglion, in the spinoglenoid notch, that produces a selective denervation of the infraspinatus muscle.
Case report
A forty-one-year-old man was admitted to the Orthopaedic Department on November 1,1984, with a one-month history of progressive pain and weakness in the right shoulder. Physical examination revealed wasting of the right infraspinatus muscle and weakness of external rotation at the right shoulder. Electromyographic findings demonstrated an isolated denervation of the right infraspinatus muscle.
An operatio n was performed on December 13,1984. Exposed infraspinatus muscle appered normal in color but was unresponsive to electrical stimulation. The acromion was cut temporarily in order to explore the course of the suprascapular nerve in the spinoglenoid notch. Pathological examination of the specimen revealed a ganglion.
Postoperatively the patient noted re l i ef of pain. An electromyogram performed one month following the operation demonstrated the sign of reinnervation of the right infraspinatus muscle. After nine months of follow-up the patient recovered almost normal strength of the infraspinatus muscle and full range of motion without pain, although atrophy of the infraspinatus mucle persisted and nerve conduction study demonstrated still slightly delayed conduction in the muscle branch of the suprascapular nerve to the right infraspinatus muscle.
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森沢 佳三, 興津 貴則, 平野 真子, 山鹿 眞紀夫, 益田 郁子, 久保田 健治, 北川 敏夫, 鬼木 泰博, 桃崎 和彦
1986 年 10 巻 1 号 p.
63-67
発行日: 1986/07/28
公開日: 2012/11/20
ジャーナル
フリー
The aim of our study was to demonstrated the results of the functional conditions of shoulder joint in high school students, and to discuss the cause of shoulder joint pain in young people.
In our study, we examined three hundred and eighty high school students (two h undred and seventy male and one hunderd and ten female).
We checked the age, history of sports and injuries of shoulder joint and other region. We checked the musc l e atrophy of shoulder girdle, the loosening of shoulder joint and anterior, posterior apprehension test. And we evaluated the range and pain of active motion, passive motion and muscle strength of shoulder joint. Most students with history of shoulder pain were observed the muscle atrophy and tenderness in infraspinatus muscle. Range of motion of shoulder joint was almost normal range. Over a quater students of all had loosening shoulder joint. The rate of loosening shoulder joint in female was a little more than that in male. About thirty percent of these students had complains of fatigability and numbness of hand with heavy weight bearing. Most students with positive result of anterior apprehension test have experienced anterior dislocation of shoulder joint and inferior instability. In most students with history of shoulder joint pain, the pain accompanied participation in certain sports, especially baseball and volleyball.
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肩関節痛との関連について
菅原 誠, 荻野 利彦, 三浪 明男, 福田 公孝, 中里 哲夫
1986 年 10 巻 1 号 p.
68-71
発行日: 1986/07/28
公開日: 2012/11/20
ジャーナル
フリー
Shoulder pain is the most common problem in sports which require throwing motion. The causes of shoulder pain are resulted to tendinitis, bursitis, recurrent anterior dislocation and impingement syndrome in many cases. During a 15-Year period, from 1960 through 1985, we encounterd 8 patients with axillary nerve palsy according to throwing motion. The average age of these patients was 17years (range 13 to 20 years). All were students participating in a sports (Baseball: 2, Volleyball: 2, Table tennis: 1, Basketball: 1, Tennis: 1, Badminton: 1). Symptoms began with onset of pain and paresthesia around the shoulder without trauma in all patients. The point tenderness was always found posterioly in the quadrilateral space. Many patients had a normal range of motion of the shoulder. Sensory disturbance of the axillary innervated area and motorloss of deltoid muscle was minimun in all patients. Length of free from shoulder pain ranged from 2 weeks to 6 months with an average length of 2.7 months. Electromyographies were performed on five patients. The deltoid was observed for reduced interference patterns and polyphasic potentials. The surface electromyograms during throwing motion were recorded from the muscles around the shoulder. The contraction of teres major and the long head of the triceps was observed during acceleration to the beginning of follow through phase. We suspected the causes of axillary nerve palsy according to throwing motion were considered following: the shoulder in abduction, extention, external rotation during wind up phase causes stretching and entrapment of axillary nerve in quadrilateral space and in abduction, flexion, internal rotation during acceleration phase causes further entrapment by contraction of teres major and the long head of the triceps. This report indicate that a player who require throwing motion could sustain a injury to axillary nerve and this injury is not so rare and has been neglected.
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松崎 昭夫
1986 年 10 巻 1 号 p.
72-74
発行日: 1986/07/28
公開日: 2012/11/20
ジャーナル
フリー
16 cases of entrapment neuropathy of the axillary nerve in the quadrilateral space were reported. Etiology, symptomatology, differential diagnosis and therapy of this disorder were discussed. The complaints of the patients were pain on the dorsal and lateral aspect of the shoulder, especially in abduction, external rotation and horizontal abduction of the shoulder.
Objective findings were sensory disturbance in the autonomo u s zone of the axillary nerve, muscle atrophy of the deltoid and the terses minor muscle and tenderness on the quadrilateral space. But in mild cases muscle atrophy was not observed. In two cases partial muscle spasmus of the deltoid and the teres minor muscle and tenderness on them were observed. In one case with muscle atrophy the electromyographic investigation showed neurogenic changes of the deltoid and the teres minor muscle: motor unit action potential were long in duration, high in amplitude and polyphasic. This case was operated on and satisfactory result followed neurolysis. In other cases there was a good response to local infiltration of steroid and procaine hydrochloride. Our cases suggest that this neuropathy might also be considered in the differential diagnosis of a patient presenting with shoulder pain. Useless diagnostic procedures and treatment can be avoided if the physician is aware of this condition.
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貞広 哲郎, 近藤 憲二, 山本 博司, 森沢 豊
1986 年 10 巻 1 号 p.
75-78
発行日: 1986/07/28
公開日: 2012/11/20
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フリー
Thoracic outlet syndrome (T.O.S.) consists of several etiologic factors and is hardly diagnosed at times. It is well known that T.O.S. develops sometimes after trauma on the shoulder, while some of symptomes of loose shoulder is similar manifestation to T.O.S. This time, we discussed on diagnostic and therapeutic problems of cases, whose shoulder disorders were possibly caused by combined T.O.S. and loose shoulder. Materials are four young females and their chief complaints are shoulder aching by motion or avulsive feeling in the shoulder by lifting items and not containing typical complaints of T.O.S. as to neuro-vascular disfunction by elevating their arms. All of cases have type I or II of loose shoulder. Case 1 had a surgery after Barkart procedure under diagnosis of recurrent transient subluxation of the shoulder (Rowe). Six months later, though she had been free of complaints, she complained of coldness, cyanosis and sensory disturbances of the limb which was relieved by transaxillary first rib resection finally. Case 2 complained of aching in the shoulder by motion or lifting items and had type H of loose shoulder which was treated by glenoid osteotomy. Though the loosening was disappeared once after surgery, she compained of snapping in front of the shoulder and the loosening recured with sensory disturbances in the ulnar side of the limb. Through these experiences above, further examinations of T.O.S. were performed on case 3 and 4, and major pectoral muscle transfer for loose shoulder was done combined with several aditional treatment respectively resulting in preferable clinical courses. It was also presented that the diagnostic value of transient augumentation of the spinal evoked potentials which was recorded in the epidural space by peripheral nerve stimulation in T.O.S.
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石橋 徹
1986 年 10 巻 1 号 p.
79-85
発行日: 1986/07/28
公開日: 2012/11/20
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This report presents my experience of shoulder-hand syndrome (S. H. S.)
Case 1. A 46-year-old woman developed S. H. S.3 months after release o p eration for contracture of her right shoulder joint. She's been relieved from symptoms after resection of her right first rib for concomitant thoracic outlet syndrome (T.O. S. ) besides stellate-ganglion blocks and steroid therapy but with mild residual Dupuytren's contracture. Case 2. A 51-year-old male clerk sustained a Colles' fracture of his right wrist.
He developed S. H. S.2 mo n ths later soon after removal of cast. He underwent release operation in the wrist and resection of his right first rib for concomitant T.O. S. supplemented by stellateganglion blocks and steroid therapy. He can now write and feed himself. Case 3. A 71-year-old man developed left S. H. S.2 months after craniotomy for right cerebral hematoma. Relief from symptoms followed reduction of old anterior dislocation of his left shoulder joint with Leeds-Keio artificial ligament used as a restraint besides steroid therapy. Case 4. A 61-year-old male worker sustained comminuted fractures in his right scapula and ribs besides head injury. One month later he developed right S. H. S.
He's overcome S. H. S. with physiotherapy and steroid therapy leaving mild Dupuytren's contracture.
Summary. S. H. S. in this report developed secondarily to trauma, dislocation or subclinical periarthritis of the shoulder, while posttraumatic immobilization or postoperative rehabilitation played important role in its development. S. H. S. has been categorized as reflex neurovascular syndrome. Each of these cases appears to have been related to double loading on the nervous system in reflex mechanism. This reflex mechanism should be broken in the treatment of S. H. S.
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N atural Course, Manipulation and Surgery
M. Takeshita, Y. Shibata, E. Matsunaga, N. Takagishi
1986 年 10 巻 1 号 p.
86-94
発行日: 1986/07/28
公開日: 2012/11/20
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フリー
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中田 和義, 斉藤 覚, 前田 道宣, 松井 猛
1986 年 10 巻 1 号 p.
95-100
発行日: 1986/07/28
公開日: 2012/11/20
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We report three cases of extra-abdominal desmoid tumors in the shoulder girdle.
Case 1. A fourty-year-old woman was admitted to our hospital with firm swelling on the anterior aspect of her left shoulder, which apparently attached to the pectralis major, biceps muscle, clavicle and humerus. En bloc resection was performed. The tumor showed a non-encapsulated, infiltrating into the adjacent muscle. The patient fell down and sustained a fracture of left humerus one year seven months after operation. At operation there was no evidence of neoplasma, although bone of the fracture site was necrotic.
Case 2. A seventee n -year-old girl came to our hospital with a seven month history of a dullache and firm swelling on the lateral aspect of her left upperarm. Examination revealed a firm and non-mobile mass lying between biceps and triceps muscle. Angiography and enhance CT showed hypervascular tumor. En bloc resection of tumors with involved muscle was performed. The tumor recurred in the deltoid muscle one year post-operation and was excised widely.
Case 3. A fifty-eight male came to our hospital complaining a firm t u mor in the proximal part of left upperarm. At operation a firm fibrous tumor was found arising from the long head of the biceps muscle. In the nine months since the treatment there is no recurrence in the upperarm. Desmoid tumors is locally invasive, non-metastasising neoplasms with high recurrence rate after inadequate excision. A further surgical treatment for the recurrent tumors is difficult, the function of the joint becomes worse. Complete surgical excision is necessary at first operation.
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中野 哲雄, 坂本 憲史
1986 年 10 巻 1 号 p.
101-104
発行日: 1986/07/28
公開日: 2012/11/20
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フリー
A case with chondromatosis originated in the subacromial bursa. Since the report of Reichel in 1900, numerous reports have been published on osteochondromatosis, however, the etiologic nature has not been clarified at present. Osteochondromatosis occurs mostly in the knee joints and the bursal involvement is infrequent. The occurrence in the region of shoulder joints and bursa is particularly rare. Only 2 cases have been reported in Japan as yet to our knowledge.
Our case is a 37 year old man, who has been complainy of shoulder pai n since Ton,1982, when he got a bruise on his right shoulder. Reconstructive surgery was done for the rapture of rotator cuff in April 1983. After the procedure, the pain subsided, but it recurrent at hard muscle work in Feb.1984. Re-operation was carried out with the diagnosis of re-rupture of rotator cuff. At operation, numerous cartilagenous granules were scattered around the subacromial bursa. Histologic findings of them revealed the chondromatosis arising from bursa. Subacromial bursectomy and Mclaughlins'method reconstruction of R. C. were performed. The symptoms disappeared and the signs of recurrence are not detected thereafter.
The leading hypothesis of genesis of Osteochondromatosis include mataplasia theory of Tabira and tumor. Trauma has also been reported as an inducing factor on rare occasions. The interesting feature of this case is that the operative procedure or slik suture may have contributed to the development of osteochondromatosis, because it become manifect one year after the first operation, when the chondroma was not seen at all.
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永由 明弘, 石川 勝, 藤巻 悦夫, 小林 直人, 中島 清隆, 広瀬 秀史, 関水 正之
1986 年 10 巻 1 号 p.
105-110
発行日: 1986/07/28
公開日: 2012/11/20
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Purpose: We have some difficulty in selecting operative method under indefinite diagnosis of tumor. And is there an operative indication for metastatic tumor ? If is there, radical or meet ?
We submit 2 cases of tumor in Humerus caput and consider how must we orthopaedic surgeo n manage such condition.
Case: Case 1.21 male C. C. was right side omalgia since one year ago. ROM was limited from pain, flex.110°, abd.100°, ext. rot.10°.
Nevertheless pathological findin g that indicated malignancy, we adopted curettage of tumor and bone graft because of its clinical findings such as X-ray film, Tc, Ga scintigraphy, angiography, and CT-scan. After operation, its diagnosis was aneurysmal bone cyst. Evaluation of ROM after 5months was flex.160°, abd.160°, ext. rot.70°, and had no pain.
Case 2.50 female C. C. was left side omalgia hyste r ectomy and lymphatectomy was done because of uterus carcinoma on her 49 year-old. So this tumor was suspected metastasis. Her ROM was flex.45°, abd.50°, ext. rot.5°. But we could not gain malignant sign from pathological finding that was suspected malignancy from anamnesis. We did operation consist of excision of tumor and fixation with Rush pin and bone cement, because the another metastatic point was not find and her general condition was good. But 1.5 years later, she died from multiple metastasis.
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益田 郁子, 森沢 佳三, 原田 正孝, 高木 克公, 北川 敏夫
1986 年 10 巻 1 号 p.
111-114
発行日: 1986/07/28
公開日: 2012/11/20
ジャーナル
フリー
The purpose of this report is to study the function of shoulder joint which was treated with various procedures for bone tumors and tumorous conditions of the proximal humerus.
In our series, there were five bone cysts, three primary bone tumors and two metastatic bone tumors.
Five patients with bone cyst were treated with curettage and bone graft. Five patients, who were three with primary bone tumors and two with metastatic bone tumors, were treated with replacement of humerus head. But one who had metastatic bone tumor had died within one week after operation. Therefore, in nine patients except one, we examined the active motion, passive motion and muscle strength of the shoulder joint, and activities for dairy life. The functional results of shoulder joint of the five patients with curettage and bone graft, and of two patients with replacement of humeral head were sufficient, but that of two patients with replacement of humerual head were insufficient. All patients with replacement of humeral head continued to enjoy near-normal elbow, forearm, wrist and hand function. However, one with replacement of humeral head for osteosarcoma underwent four quater amputation for local recurrence after one year.
The replacement of humeral head is one of the good procedures for the maintemance of extremity function, but we must have attention with local recurrence and metastasis.
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森 修, 森沢 佳三, 北川 敏夫
1986 年 10 巻 1 号 p.
115-117
発行日: 1986/07/28
公開日: 2012/11/20
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フリー
27 tumors of the scapula encountered in patients at the Kumamoto University have been analyzed. Tumors of the scapula accounted for about 2 % of total bone tumors. In 27 tumors,13were benign tumors or tumorous conditions,6 were primary malignant tumors and 8 were metastatic tumors. Total scapulectomy was carried out on three cases (Renal cancer metastasis, Angiosarcoma, Chondrosarcoma). No recurrence and no metastasis has occured and postoperative function of upper extremity was fairly retained in all cases. We consider that total scapulectomy is the radical and usefull procedure to malignant tumors of the scapula at the point of function.
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森下 忍, 阿部 宗昭, 茂松 茂人, 小野村 敏信
1986 年 10 巻 1 号 p.
118-121
発行日: 1986/07/28
公開日: 2012/11/20
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A case report of the girl of abduction and internal rotation contracture of the shoulder joint with infero-posterior dislocation following birth palsy, who underwent the operation of muscle release and reduction of the dislocation, is written.
A one-year and 9 months old girl with a history of palsy of the left upper extremity after birth was first seen in June 1982. Her birth weight was 4500 grm. An abduction of the shoulder gradually improved, but peculiar abduction and internal rotation deformity developed.
On admission in June 1982, the left shoulder joint positioned in abduction (70°) and internal rotation (100). The external rotation was limited markedly. The roentgenograms of the shoulder joint showed the hypoplastic glenoid and humeral head. The head of humerus dislocated posteriorly to the glenoid. Myelograms revealed pseudomeningocele in C6,7,8r, o ot level.
Operative findings evideneced that the humeral head was bisected an d faced posteriorly. When the shoulder joint rotated externally, the head of humerus dislocated inferiorly. The section of the coracoacromial and coracohumeral ligaments did not improve the internal rotatory contracture. Release of the severely tensed subscapular muscle and joint capsule made the humeral head reduction in normal position.
Three years later, at the time of follow up, deformity of the shoulder joint has been corrected and motion of the external rotation improved. Pathomechanism of the dislocation of the humeral head following total type birth palsy is different from the upper type. Initially, this case is seemed to be total type paralysis. Reinnervation of the deltoid and biceps muscles made the shoulder abduction and the elbow flexion, and weight of the upper arm forced the shoulder joint internal rotatory position. Additionally, the subscapular muscle recovered. These muscle imbalance forced the shoulder posterior dislocation associated with internal rotation contracture.
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桜井 実
1986 年 10 巻 1 号 p.
122-124
発行日: 1986/07/28
公開日: 2012/11/20
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Disability of arm elevation in facioscapulohumeral type muscular dystrophy is produced by instability of the scapula but not by weakness of the deltoid muscle. When the scapula is fixed on the thorax, patient can elevate the arm.
The scapula was denuded and fused on the ribs with a Tetron lace. In order to obtain sufficient elevation of the arm the scapula was abducted in 30°. Six operations in three patients ranged from seven to fifteen years of age, were experienced. After the operation they could restore good elevation in approximately 130°-145° abduction and flexion. Bony fusion was confirmed clinically and on radiography within two years following operation. The patients reaching almost twenty years of age still keep good result and are able to enjoy sports as tennis, but the youngest case whose clinical feature progressed, became bed-patient.
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飯塚 久晴, 室田 景久, 富田 泰次, 別当 武治
1986 年 10 巻 1 号 p.
125-127
発行日: 1986/07/28
公開日: 2012/11/20
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Seven cases of arthrodesis of shoulder joints were performed using new method in our university hospital since 1982.
This new m ethod is really simple and easy going, that is to say, two or three Kirschner's wires are drilled into the acetablum through the humeral head and also two or three suture wires are put into the edge of the acetablum or acrominal portion, then solid fixation is performed using these Kirschner's wires and suture wires as packing system. As far, postoperative rehabilitation, the program could be started earlier than in other methods because of using none of cast. Three of seven cases are male, four cases are female, age of operative time ranged from 18 years to 51 years, average is 31 years 5 months, follow-up period ranged from 8 months to 2 years 10 months, average is 1 year 4 months, List of diseases are four cases of brachial plexus injuries, one of RA, one of posttraumatic arthritis and one of poliomyelitis.
Results of follow- up studies, solid fixation was obtained in all cases, so that no case got loosening of shoulder joint after surgery. All patients have no complains and their ADL are improved.
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酒井 直隆, 腰野 富久, 渡辺 靖年, 森岡 健
1986 年 10 巻 1 号 p.
128-131
発行日: 1986/07/28
公開日: 2012/11/20
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Shoulder arthrodesis was done in 6 shoulders with brachial palsy of 6 patients (5 men and 1women, with the age raging 11 to 56 years, averaging 39.2). Follow-up periods ranged from 1 to 14years. The brachial palsy was caused by trauma in 4 patients, by birth palsy in one, and by resection of a malignant tumor in one. The shoulder was fixed with AO compression screw and bone nail. Bone chips were grafted into the space between acromion and humeral head. Steindler's operation was done before arthrodesis on 5 patients except for a case with birth palsy. Arthrodesis was succeeded in all patients. And the expected shoulder position was acquired in all ones.
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河井 秀夫, 山本 浩司, 山沢 猛, 政田 和洋, 川端 秀彦, 多田 浩一
1986 年 10 巻 1 号 p.
132-136
発行日: 1986/07/28
公開日: 2012/11/20
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We present nine cases of shoulder fusion in traumatic brachial plexus palsy for the last eight years.
All sustained an injury by motorcycle accident. Age at shoulder fusion ranged from 17 years to 42 years averaging 22 years. There were eight males and one female, right side in two cases and left side in seven cases. Nerve root avulsion injuries were found in eight cases out of nine cases. There was whole type palsy in three cases, upper type palsy in five cases and lower type palsy in one case. Duration between onset of injury and shoulder fusion averaged 12.2 months ranging from 5 months to 1 year and 6 months. Shoulder fusion was performed at 8.4 months on the average after cross-nerve suture on musculocutaneous nerve by intercostal nerves or accessory nerve in eight cases out of nine cases. Shoulder fusion was performed at abduction of 43.1 degrees, flexion of 26.9 degrees and internal rotation of 25.7 degrees on the average. Fusion was sound in all cases.
ADL has much improved in six cases with a well controllable hand to rea c h the mouth, anal region and back. In three cases with an incompletely controllable hand strength of elbow flexor increased with good nerve regeneration and it was easy to hold an object by adduction and elbow flexion after fusion of the shoulder.
One case complicated h umeral neck fracture by a fall but bony union was good after external immobilization.
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原 好延, 松田 英雄, 呉家 守二, 横山 一郎, 舟越 晃一, 島津 晃, 近藤 正樹
1986 年 10 巻 1 号 p.
137-140
発行日: 1986/07/28
公開日: 2012/11/20
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フリー
Since 1974,16 cases of flail shoulder caused by traumatic brachial plexus injuries (2 upper cases,4 upper and middle, and 10 total) were reconstructed by transferring the trapezius, levator scapulae and/or pectoralis minor muscles, rather than by fusing the shoulder. These muscle transfers were done after neurolysis and transfer and grafting of nerves. In 6 of these 16 cases, the Modified Bateman method (Saha) was used to transfer the trapezius muscle. The Modified Saha (MS) method, retaining the lateral half of the A-C joint, was used in one case, and the MS method combining bone grafting for greater arm leverage and reduced cosmetic defects was used in 7 cases. In 1 other case, the MS method was used together with the transplanting of a graft of palmaris longus onto the acromion to prevent anterior slippage of the trapezius which was transferred to the humerus. And in 1 case, the MS method was used in which trapezius muscle was divided into 2 parts, then transferred to the 'anterior and posterior aspects of the humerus to prevent internal rotation in abduction.
The abduction range in the standing position was 30-40 degrees for the Saha method, and 30-80degrees for the MS method. In evaluating these results, however, consideration of the degree of palsy around the shoulder and the type of operation performed is necessary.
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