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中川 照彦, 石突 正文, 古屋 光太郎, 石田 明允, 森脇 正之
1991 年 15 巻 2 号 p.
189-194
発行日: 1991/09/01
公開日: 2012/11/20
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フリー
Thirteen male subjects' pitching motions were analyzed by electromyography and a motion measurement system. Shoulder motion was measured by a magnetic sensor system ( ISOTRAK )quantitatively. Three kinds of angles, that is the latitude, longitude and rotation, were used to describe the three dimensional motion of the shoulder complex. Six channels of electromyograph were available and EMGs were induced by disposable skin electrodes. Electromyographic signals were recorded from the pectoralis major, the latissimus dorsi, the deltoid, the trapezius, the biceps and the triceps. The motion data and EMG data were fed to a personal computer and displayed.
The pitching motion was divided into four phases : early cocking, late cocking, acceleration and follow-through.
An external rotation of an average 107 degrees occurred during the cocking phase, and then an internal rotation of an average 84 degrees occurred during the acceleration phase.
In skilled men, the pectoralis major became active from the late cocking to the follow-through. The deltoid and trapezius became active at the early cocking and the end of the cocking period. The biceps and triceps became active at the end of the cocking period.
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森脇 正之, 石田 明允
1991 年 15 巻 2 号 p.
195-199
発行日: 1991/09/01
公開日: 2012/11/20
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Three dimensional motion of the scapula and the glenohumeral joint was a nalyzed in flexion, elevation in the scapular plane ( 45 degrees towards the front of the coronal plane ), and abduction with and without a 2 kg load.
Materials and Methods
The right shoulders of nine males were measured. The age of the subjects ranged from 24 to 33years, averaging 27.3 years.
For analyzing thre e dimensional motion, a 3 space tracker system ( a product of McDonnel Douglas Electronic Company ) was employed. The 3 space tracker system was composed of a source -coil which was attached to the sternum, and three sensor-coils.
The first sensor-coil was attached to the lateral e n icondyler portion of the humerus. The second sensor-coil was attached to the spine of the scapula and the third sensor-coil was employed to measure the three dimensional position of the scapula in the arm dependent position.
The 3 space tracker system could measure three Euler's angles of the hum e rus, the scapula and the glenohumeral joint, and could measure the distance from the source-coil to the sensor-coil. Results
The patterns in the three planes were no different with or without loads.
In maximum elevation, the three Euler's angles of the scapula of a s u bject were the same in au three planes.
The percentage of the glenohumeral elevation angle to the arm elevation angle in elevation decreased in flexion,70 % in abduction, and changed polyphasicly in elevation in the scapular plane.
The scapula did not move medially until! 130 degrees in flexion, but in abduction it m oved medially from 50 degrees on.
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伊藤 信之, 衛藤 正雄, 手島 鍛, 岩崎 勝郎
1991 年 15 巻 2 号 p.
200-204
発行日: 1991/09/01
公開日: 2012/11/20
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フリー
There are many articles on the capsular mechanism for preventing ant e rior shoulder dislocation, but few reports on the dynamics of the dislocation. This study investigates the dislocation based on dynamics.
Anterior dislocation usually occurs when an object bumps posteriorly against the forearm while in the abduction position. If the force acts posteriorly at a distal place from the gravity center of the upper extremity, the center will move posteriorly at a speed of F/M ( F: force, M: mass of the upper extremity ) and the humeral head will rotate anteriorly as an angular velocity ( ω ) ( ω = F h/I, h: distance between the gravity center and action point, I: moment of inertia ). So the head will move anteriorly at a speed of ω ⋅-F/M ( x: distance between the gravity center and the humeral head ). Because the gyration radius of the extremity is larger than the radius of the glenoid, a Bankart's lesion will occur.
The volume of the upper extermity of a young male was measured at the same length rate and the weight was calculated as the specific gravity-one. The moment of inertia was 0.105kgm. If the force (10N ) acts on the distal place ( h= 40cm ), the humeral head will move 5.4cm anteriorly during 0.01 seconds. The capsule and rotator cuff muscles will be stretched, but the stretch reflex of these muscles will not prevent a movement of the head, because the reflex will not happen during 0.01seconds.
If the moment of inertia is made larger, the incidence of the anterior dislocation may decrease.
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斎藤 覚, 中土 幸男, Loren Latta, Edward Milne
1991 年 15 巻 2 号 p.
205-211
発行日: 1991/09/01
公開日: 2012/11/20
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フリー
In order to improve results of surgical treatment for the displaced proximal humeral fractures and to better understand the prevalence of osteoporosis in the proximal humerus, we measured the bone mineral density and the mechanical strength of the cancellous bone as well as roentgenograms of the proximal humerus. Bone mineral density was measured with the dual photon absorptiometry (DPA) and mechanical strength of the cancellous bone with the indention test. The results were compared with those of proximal femur in the same individual. In addition, a biomechanical study was performed on the effect of osteoporosis over the strength of the internal fixation for a simulated 2-part fracture.
The humeral head had two thirds bone mineral density and a half mechanical strength in indention test of the femoral head. The humeral neck had a half bone mineral density of the head and its cancellous bone showed only one third mechanical strength of humeral head when we compared the average of energy required to indent 5 mm in 9 standardized points on each bone slice. That the top of the humeral head is the strongest part within the head was first observed in the DPA images and was confirmed by analyzing the bone mineral density as well as by the indention test.
The screws used to fix the humeral head to an aluminum plate provided with statistically less stability in the osteoporotic group than those inserted into the non-osteoporotic humeral heads.
The fact that the proximal humerus is more osteoporotic than the proximal femur and that the strongest part of the proximal humerus is located at the top of the head appears to be one of the causes of failure in internal fixation for the displaced humeral fractures.
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中島 清隆, 阪本 桂造, 片桐 知雄, 広瀬 秀史, 小川 剛司, 竹政 敏彦, 白土 貴史, 藤巻 悦夫
1991 年 15 巻 2 号 p.
212-218
発行日: 1991/09/01
公開日: 2012/11/20
ジャーナル
フリー
( Purpose ) With the development of degeneration, the tendon markedly decreases in elasticity and becomes fragile. This is considered attributable mainly to the degeneration of the collagen fiber. But we postulate that calcification of the tendon fiber might be partly concerned with the process of the tendon becoming fragile. We collected supraspinatus tendons in various age groups to determine tissue calcium levels and examined them under a transmission electron microscope.
( Method ) The subjects were 30 cases of supraspinatus tendon ranging in age from 17 to 90 years which were obtained from fresh cadavers and by operation. The tissue collected was dried at 105°C for 48 hours, decomposed with nitric acid and perchloric acid and then subjected to atomic absorption analysis to determine its calcium levels. A comparative study, using a transmission electron microscope, was also conducted on 6 cases of all age groups.
( Results ) 1) Aging was proportional to the calcium levels in the supraspinatus tendon, the coefficient of correlation being 0.676.
2) Under the electron microscope, the tendon fiber had a well-defined contour of the margin in the young, but it was swollen and the margin was mostly obscure in the elderly. The tendon fiber of the middle-aged showed a microscopic tear preceding degenerative changes.
( Conclusion ) Microscopic calcification may be concerned with the pathologic process of the supraspinatus tendon becoming fragile.
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仲川 喜之, 梅垣 修三, 尾崎 二郎, 冨田 恭治, 桜井 悟良
1991 年 15 巻 2 号 p.
219-222
発行日: 1991/09/01
公開日: 2012/11/20
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フリー
The purpose of this report is to evaluate the histological changes of the symptomatic calcific tendinitis in the shoulder and decide the most reasonable treatment on the individual basis, depending on symptoms and X-ray findings.
This study was composed of 18 patients ( 4 were males and 14 were females ) out of 180 patients. Their average age was 51.9 ranging from 36 to 74. The histological changes were observed in 4 parts; the deltoid muscle, the roof of the subacromial bursa ( SAB ), the floor of the SAB, the rotator cuff. The histological study revealed a slightly mild inflammation associated with some small ro u nd cells in the deltoid muscle, mild inflammation associated with a few neutrophis in the roof of the SAB, necrosis and calcific deposits; severe inflammation associated with numerous neutrophils; giant cells in the floor of the SAB; and more slightly milder inflammations associated with a few small round cells in the rotator cuff.
We conclude that the main c a use of symptoms of symptomatic tendinitis calcarea is a severe inflammation associated with necrosis, calcific deposits, neutrophils and giant cells in the floor of the subacromial bursa. Therefore, so-called "Symptomatic tendinitis calcarea" should be considered to be "Calcific subacromial bursitis". "Calcific subacromial bursitis" should be treated, first, by aspiration and infusion, secondly, by surgical excision of the calcific deposits including the subacromial bursa, but excluding the rotator cuff, and on occasion anterior acromioplasty.
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薄井 正道, 石井 清一, 青木 光広, 内藤 貴文, 山下 元吉
1991 年 15 巻 2 号 p.
223-227
発行日: 1991/09/01
公開日: 2012/11/20
ジャーナル
フリー
Two patients with osteosarcoma and two with chondrosarcoma occurring in the proximal end of the humerus were treated by wide resection of the tumor and free vascularized fibular bone graft. The age of the patients ranged from 10 to 43. Osteosynthesis between the grafted fibula and the proximal end of the humerus was carried out by plate and screw fixation. The fibula head was fused with the scapula in one case and suspended from the remaining scapula by a free tendon graft ( Sling Procedure ) in three cases. The functional results were evaluated by a remodified Enneking's sys tem. There was no local recurrence in any of the four cases. Although one patient died due to pulmonary metastasis 2 years and 6 months after the tumor resection and 1 year after the free vascularized fibular graft, the 3 other patients showed no signs of disease. The functional results ranged from 72%to 88% with an average of 81%. Although the functional results of the patient with a shoulder fusion was the best ( 88% ), it took almost one year to achieve solid fusion due to a stress fracture of the proximal part of the fibula. On the other hand, the three other patients in whom the grafted fibula was suspended from the remaining scapula by a free tendon graft ( Sling Procedure ) could use their reconstructed limb two months after surgery and their functional results were also satisfactory. Sling Procedure is another useful method for the reconstruction of a bone defect of the proximal end of the humerus after wide resection of the tumor.
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広瀬 和哉, 石井 清一, 薄井 正道, 青木 光広, 小沢 寿樹
1991 年 15 巻 2 号 p.
228-232
発行日: 1991/09/01
公開日: 2012/11/20
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フリー
There have been few reports on synovial osteochondromatosis in the subacromial bursa. We have experienced a case of synovial osteochondromatosis in the subacromial bursa ( case 1 ), a case of huge calcium deposits in the subacromial bursa assocdated with synovial osteochondromatosis (case 2) and case of fumoral calcinosis around the subacromdal bursa ( case 3 ). Radiological analysis was performed on these casen which showed a synovial ostechondromatosis-like shadow in the subacromial bursa.
Case 1: A 37-year-old female. The X-ray film of her left shoulder showed 4 calcified free bodies in the subacromial bursa. A bursoscope revealed only the free bodies without any synovitis inside the bursa. Pathological examination of the synovial tissue demonstrated that there were no inflammatory signs nor metaplastic osteochondral cells. We diagnosed it as synovial osteochondromatosis ( Milgram phase III).
Case 2 An 8 5-year-old female. The X-ray film showed multiple lobular calcification and several calcified free bodies in the subacromial bursa, the subdeltoid bursa, and the subcoracoid bursa. The mass of lobular calcification was markedly reduced within one year after multiple of corticosteroid into the bursa, although the free bodies remained unchanged. We concluded that this pathological condition was calcifying bursitis and synovial osteochondromatosis.
Case 3: A 53-year-old female. She complained of painles s swelling of the anterior aspect of her right elbow, the posterior aspect of her right shoulder, and the anterior aspect of her left shoulder. She cad undergone haemodialysis from 1980 until recently. The X-ray film showed shadows of multiple lobular calcification around the bilateral subacromial bursa, the subdeltoid bursa and the right elbow joint. Pathological examination of the tumor showed multiple cysts separated by connective tissue septa. There was an area of necrosis at the center of the tumor which was surrounded by a diffuse mass of calciffication. The macrophages of foreign body reaction surrounded the calcified mass, and these multiple foci constituted the tumor. We diagnosed it as tumoral calcinosis.
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自験例5例と報告例の検討
荻野 利彦, 木村 長三, 三浪 明男, 加藤 博之, 柴田 理恵子, 鈴木 克憲
1991 年 15 巻 2 号 p.
233-237
発行日: 1991/09/01
公開日: 2012/11/20
ジャーナル
フリー
Entrapment neuropathy of the suprascapular never by a ganglion is a rare entity. Since 1970, only 21 cases have been reported. Most of the cases cited had usually not been diagnosed prior to operative intervention. The authors reported on a similar patient in 1989. In this paper, five cases of suprascapular nerve palsy by a ganglion including that case are reported and the usefulness of ultrasonography in confirming the diagnosis is discussed. The complaints presented were pain around the shoulder and weakness of external rotation. All four patients had a marked tenderness in the infraspinatus fossa and a wasting of the infrasipnatus muscle. Electromyographic studies showed delayed terminal latency of the inferior branch of the suprascapular nerve in all cases except one. The diagnosis of a ganglion as the agent producing compression of the suprascapular nerve was made with the help of ultrasonography in all five patients prior to instituting any treatment and it was also made with a CT in four patients. The ganglion was found at the spinoglenoid notch in four cases and between the scapular and spino-glenoid notches in one patient. The ganglion and the pedicle were excised. The patients made uneventful recoveries with immediate relief of pain.
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保坂 正人, 中土 幸男, 斎藤 覚, 北側 恵史, 松田 智, 土金 彰
1991 年 15 巻 2 号 p.
238-243
発行日: 1991/09/01
公開日: 2012/11/20
ジャーナル
フリー
Seventeen cases ( 8 males and 9 females ) of peripheral nerve paralyses associated with fractures or fracture-dislocations of the proximal humerus and dislocations of the shoulder joint were studied. The patients' ages ranged from 17 to 85 years with an average of 56.9 years. The lesions of paralyses consisted of 7 brachial plexuses,7 axillary nerves, one with both axillary nerve and suprascapular nerve and 2 median nerves.
Open reductions were performed in 10, and closed reductions were made in the remaining 7. Two cases underwent surgical explorations of the nerves secondarily after reduction. One had a complete tear of the axillary nerve which was repaired using nerve grafting, and the other had an incomplete tear of the axillary nerve on whom neurolysis was performed.
Thirteen cases were followed electromyographically after reduction. Nine of the 13 had denervations, and 4 of the 13 had polyphasic waves. Among 9 cases, which showed a denervation at the first examination, nascent units were observed within 2 to 4 months after the injury.
Most cases of paralyses associated with fractures or fracture-dislocations of the proximal humerus and dislocations of the shoulder joint recovered spontaneously. However, surgical intervention should be considered for the nerves in those cases without regenerating findings in the EMG within the 4 months after injury.
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西島 直城, 瀬戸 洋一, 土屋 隆之, 山室 隆夫, 二見 徹
1991 年 15 巻 2 号 p.
244-246
発行日: 1991/09/01
公開日: 2012/11/20
ジャーナル
フリー
For a patient with total loss of shoulder control or in whom transfers are not possible, arthrodesis of the glenohumeral joint is the salvage procedure. The mobility of the shoulder should be preserved if there is any possibility of providing muscular control by means of multiple muscle transfers. Twenty five patients underwent functional reconstruction because of shoulder paralysis excluding those with birth palsy.
If a patient's C8 and Thl roots were in functional condition, and his latissimus dorsi and pectoralis major were also functional, the results of multiple muscle transfer surgery were successful. The trapezius, the levator scapulae and the latissimus dorsi were available for these operations.
Ten of the patients whose Thl roots only were in functional condition could flex the i r wrists and fingers. They could not, however, extend their wrists or fingers. Tendon transfer surgery on their hands was successful. When the trapezius and the levator scapulea were available for shoulder functional reconstruction, the results were satisfactory. They could adduct their shoulders by the pectoralis.
In paralysis involving a whole brachial plexus with avulsion of the roots, we attempted to restore elbow flexion using interconstal nerves. The results were successful. But in these cases, multiple muscle transfers were not successful due to a lack of available muscles. In three of the cases with a weak trapezius, arthrodesis of the glenohumeral joint was done. In six of the cases with a strong enough trapezius, the trapezius was transposed to the humerus. Even for patients with a whole brachial plexus injury, arthrodesis of the glenohumeral joint is not always indicated.
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川端 秀彦, 河井 秀夫
1991 年 15 巻 2 号 p.
247-250
発行日: 1991/09/01
公開日: 2012/11/20
ジャーナル
フリー
We operated on 13 patients with birth palsy who had dysfunction of the shoulder. Five external rotation osteotomies of the humerus were performed, two of which were combined with muscle transfer of the latissimus dorsi for external rotator reconstruction. Four combined trannfers of the latissimus dorsi muscle and the pectoralis major muscle and four combined transfers of the trapezius muscle and the latissimus dorsi muscle were performed. The gain in external rotation by osteotomy immediately after the operation was equivalent to the angle rotated. In the three cases without the latissimus dorsi muscle transfer, however, the gain decreased year by year and the gain had been totally lost at the final follow-up. On he other hand, the gain was maintained in cases with simultaneous latissimus dorsi muscle transfers. When the latissimus dorsi and the pectoralis major muscles were transferred, external rotation improved from-21 degrees to 33 degrees and the gain has been maintained. In addition, improvement in abduction was found in three of the five osteotomy cases and one out of the four muscle transfer cases of the latissimus dorsi and the pectoralis major. After muscle transferes of the trapezius and the latissimus dorsi, abduction improved from 50 degrees to 100 degrees and external rotation improved from-8 degrees to 12 degrees.
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鈴木 克憲, 三浪 明男, 糸賀 英也, 小林 昌幸, 高原 政利, 高畑 智嗣, 木村 長三, 福田 公孝
1991 年 15 巻 2 号 p.
251-256
発行日: 1991/09/01
公開日: 2012/11/20
ジャーナル
フリー
Shoulder arthrodesis is a useful procedure to obtain a painless and stable joint. The functional results of shoulder arthrodesis between those patients who had good forearm function and those who had forearm dysfunction were analyzed.
Eighteen arthrodeses have b een performed on 18 patients in the last ten years. Twelve patients had good foreamm function,6 had complete palsy of the brachial plexus palsy. The fixation devices used were screws in 11 cases of arthrodesis and plates in 5. The patients were immobilized in a spica cast for an average of 12.6 weeks postoperatively. The position of the arthrodesis was 26° abduction,29° flexion and 27° rotation for patients with good forearm function, on the other hand, for patients without forearm function, it was 21° abduction,21° flexion and 28° internal rotation. All the patients had led their lives better postoperatively. Patients with good forearm function could reach their mouths with their hands and lift something heavy. Patients with no foream function could hold something like a book between their arms and bodies. It is important to consider the position of shoulder arthrodesis, depending on whether the forearm is functioning or not.
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貞広 哲郎, 森沢 豊, 田辺 暁人, 西山 徹, 山本 博司
1991 年 15 巻 2 号 p.
257-261
発行日: 1991/09/01
公開日: 2012/11/20
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フリー
Clinical and electrophysiological analyses were made on twenty four limbs of twenty cases with thoracic outlet syndrome ( TOS ). Clinical analyses of Urschel were modified as we added the category of intermittent claudication, and spinal evoked potential ( SEP ) studies were developed.
The results of the clinical analyses were as follows: Symptoms of the peripheral n erve were observed in 23 limbs, vascular in 8 limbs, the autonomic nerve in 8 cases and intermittent claudication in 20 limbs. The results of the SEP were classified into 4 types.9 of type one showed the amplitude of waves was attenuated during arm elevation,6 of type two showed an amplitude attenuation following transient magnification,6 of type three showed a magnification of waves and 1 of type four showed no change. Wright's test and intermittent claudication correlated well with the SEP studies.
Following these analyses, we conclude that major symptoms of TOS are transient n e rvous symptoms and supposedly derive from circulatory disturbances of the nerves.
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片岡 泰文, 高木 克公, 森沢 佳三, 山鹿 真紀夫
1991 年 15 巻 2 号 p.
262-267
発行日: 1991/09/01
公開日: 2012/11/20
ジャーナル
フリー
Neurobundlegraphy of the brachial was carried out in 100 cases with T.O. S from 1986 to mid of 1990. We found that some patients had compression and also a stretching of the brachial plexus. So we classified them into four types according to the neurobundlegraphic findings.
( Type 1: only compression ) ( Type 2: compression>stretching ) ( T ype 3: compression < stretching ) ( Type 4: only stretching )
43 cases were treated surgically wi t h Roos's procedure. There were 7 males and 3 females in Type 1,9 males and 7 females in Type 2,5 males and 12 females in Type 3, and nobody in Type 4. Most of the patients in Type 1 and Type 2, who had symptoms caused by a compression on the brachial plexus, were satisfied with the results of their surgical treatment. But some of the patients in Type 3, who had symptoms caused by a stretch of their brachial plexus, were not satisfied. Surgical treatment improved the symptoms caused by compression on the brachial plexus, but not those caused by a stretch.
The K. S Band ( Kumamoto Scapula Band ) is an effective method for patients with symptoms caused by a stretch of the brachial plexus.
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石橋 徹, 三浦 信明, 三笠 元彦
1991 年 15 巻 2 号 p.
268-272
発行日: 1991/09/01
公開日: 2012/11/20
ジャーナル
フリー
Thirty-three reflex sympathetic dystrophies of the upper extremities, one minor causalgia, three minor traumatic dystrophies, twenty-two shoulder-hand syndromes, five major traumatic dystrophies and two major causalgias, have been treated in the past three years.
There were eleven males and twenty-two females. The underlying lesions were as follows: three cerebrovascular diseases, one subdural hematoma, one Pancoast tumor, one fracture-dislocation of the shoulder, one broken humeral shaft, one total shoulder arthroplasty with Neer's prosthesis, one glenoid osteotomy, three shoulder contusions, five glenohumeral periarthritis, one massive cuff tear, one dislocation of the acromioclavicular joint, three Colles' fractures, one carpal tunnel syndrome, one infection of the thumb, three lacerations of the fingers, one fracture of the small finger, and five had unknown origins.
Twenty-one were treated by stellate ganglion blockade, two by oral prazosin, seven by oral steroid, four by intravenous injection of steroid and xylocaine, two by transcutaneous electrical nerve stimulation technique, ten by Guyon's canal blockade, and one by continuous epidural blockade, with twenty satisfactory results.
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山隈 維昭, 津留 隆行, 鬼木 泰博, 森沢 佳三, 片岡 泰文, 山鹿 真紀夫, 大串 幹, 原田 正孝
1991 年 15 巻 2 号 p.
273-277
発行日: 1991/09/01
公開日: 2012/11/20
ジャーナル
フリー
From January 1988 to April 1990, we had 1709 athlete patients in our clinic.149 of them had complaints of shoulder problems.
There were 22 injuries and 127 over-used disorders of the shoulder. The number of cases with shoulder disorder was mostly among baseball players.
Dislocation of the acromio-clavicular joint w as present in most injuries of the shoulder. And so called baseball shoulder was the most prominent of the over-used disorders of the shoulder.
32 of these cases had shoulder instability which is of the important factors which induces a shoulder disorder.
We tr e ated mainly conservatively. Most of the patients recovered and are satisfied. We belive that correcting the playing form is very important in preventing further shoulder disorders.
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渡會 公治, 酒井 宏哉, 村上 俊, 竹田 秀明, 小黒 賢二, 鮫島 康仁, 安 相煥
1991 年 15 巻 2 号 p.
278-281
発行日: 1991/09/01
公開日: 2012/11/20
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フリー
The purpose of this paper is to consider the mechanism of shoulder girdle injuries. Rugby is a contact sport which may be one of the most dangerous sports. We examined the charts of the Sugadaira summer clinic, which is open during the summer season. Every summer, at Sugadaira highlands,750 teams get together and practice for the autumn league matches. Most of the injured athletes visit our clinic. In 1988 and 1989, we treated 1,754 rugby players, of which there were 242with shoulder girdle injuries ( 13.7% ). There were 75 Glenohumeral dislocations or subluxations,69clavicular fractures,43 injuries of the acromio-clavicular joint and 7 sterno-clavicular joint injuries. The average age of all the patients was 18.4 y. o., but in the clavicular fracture, the average was 17.4 y. o. There were 123 forward players and 112 back players, The most frequent cause was tackling ( 69.9% ). We did some research by questionnaire about past injuries of the rugby players. A half of the players ( 44.5% ) had previously injured their shoulder girdles, and 13.1% of the players thought their shoulder injuries were the most severe injury. The shoulder girdle is one of the most vulnerable regions in the human being. Strong force in rugby sometimes causes clavicle fractures and sometimes A-C separations and sometimes injuries of the insertion of the trapezius muscle.
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柚木 脩
1991 年 15 巻 2 号 p.
282-286
発行日: 1991/09/01
公開日: 2012/11/20
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フリー
The relationship between rest and X-ray findings are important to avoid a prolonged discontinuation in throwing.
[Method] I tried to manage 36 lesions with a "menu" in accordance with the development of the movement of throwing. The X-ray findings ( the degree of the widening at the epiphyseal lines )were negligable.
[Results] All the boys recovered and played baseball 2 months later with no recurrence. All the boys can throw a fast ball.
[Consideration] If em p hasis is placed on the way to throw in accordance with the development of the movement of throwing, the widenings will close eventually.
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スポーツ障害を中心に
原 好延, 廣橋 賢次, 大川 得太郎, 大橋 弘嗣, 島津 晃
1991 年 15 巻 2 号 p.
287-291
発行日: 1991/09/01
公開日: 2012/11/20
ジャーナル
フリー
We have experienced 4 cases of glenoidal limbus tears suffered in sports activities especially baseball. These limbi were either resected or sutured. However, the symptoms did not disappear with surgical resections or sutures. Therefore, other combined pathogenic factors were considered for residual symptoms, for example tears in the rotator cuff, impingement syndrome, subluxation and so on. According to Snyder's classifications, these cases were Type I, Type III, and Type IV. The case of a 58-year-old male could not be classified. A 17-year-old male was Type I and his lesion was trimmed under arthroscopic procedures. The outcome was unsatisfactory. An 18-year-old college baseball player was Type III, a flap limbus tear of the posterior part was seen arthroscopically and it was resected openly.
Bankert's lesion wa s sutured using Craig Morgan's technique and also the rotator interval was repaired. The outcome was excellent. A 19-year-old female college tennis player was Type IV. Her Bankert's lesion was sutured under arthroscopy with resection of the posterior limbus tear flap. The outcome was that she can play tennis, but feels pain when serving. Another was a 58-year-old male case. He played baseball as a pitcher until he was 40 years old. A big limbus tear was noticed in this case. It was trimmed openly. He still complains of omoarthralgia. We think that accompanying lesions are very important in the treatment of glenoidal limbus tears.
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緑川 孝二, 竹下 満, 原 正文, 高岸 直人, 岩本 英明
1991 年 15 巻 2 号 p.
292-296
発行日: 1991/09/01
公開日: 2012/11/20
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フリー
i ) Intra capsulal injuries: We perpormed arthroscopic examinations on fifty shoulder injuries resulting from sports activities. All of them jenderwenr intraarticular blocks with a local anesthetic which proved effective in controlling the pain.
The abnormal findings were categorize d as follows: single labral tear, Biceps-Labrum complex injury, Inferior G-H ligament-labrum complex injury, rim rent and others.
We performed arthroscopic operations on these cases,3-5 mont h s after the operation, all the cases resumed their sporting activities.
ii ) Impingement syndrome: We performed arthrocopic subacromial decompression ( ASD) positively for impingement syndrome. The results of the ASD were gratifying enough to permit the patients to return to their sporting activities.
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米田 稔, 冨田 哲也, 妻木 範行, 広岡 淳, 林田 賢治, 脇谷 滋之, 河村 禎人
1991 年 15 巻 2 号 p.
297-300
発行日: 1991/09/01
公開日: 2012/11/20
ジャーナル
フリー
To clarify the effect of surgical treatment for the “painful throwing shoulder syndrome”, we studied 80 throwing or overhand athletes who were followed up for at least 1 year ( mean: 31 months )postoperatively. The mean age at the time of operation was 22 years ( 13-53 ), and the sport was baseball in 59 cases, volleyball in 7 cases, tennis in 6 cases, and some other sport in 8 cases. The diagnosis at the time of operation was the impingement syndrome in 44 cases, a labral tear in 19cases, anterior subluxation in 10 cases, posterior subluxation in 3 cases, multidirectional instability in 2 cases, and other in 2 cases. Intraarticular procedures were performed in a total of 62 cases, including arthroscopic debridement in 33 cases, stapling in 26 cases, open capsulorrhaphy in 6 cases, modified Bristow's method in 3 cases, and other in 3 cases. Open or arthroscopic subacromial decompression was performed on 46 patients. In 28 of these cases, the afore-mentioned intraarticular procedures were performed in combination. An improvement in pain during throwing or overhand action was observed in 68 cases ( 85 % ).61 patients ( 77 % ) were able to return to playing sport, but only 4 out of 15 pitchers ( 27 % ) were able to return to their previous level of pitching. The reasons for these unfavorable results were thought to be problems with the diagnosis ( especially, with the evaluation of instability ), the indications for surgery, and the surgical techniques, but there are still many points which remain to be clarified. In order to improve the results, along with elucidating the pathology of a “painful throwing shoulder” it is also necessary to develop more physiological and anatomical reconstruction techniques.
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弘田 裕, 渋田 秀雄, 吉田 耕志郎, 玉井 和哉
1991 年 15 巻 2 号 p.
301-303
発行日: 1991/09/01
公開日: 2012/11/20
ジャーナル
フリー
Thirty-six sportsmen with recurrent anterior dislocation or subluxation of the shoulder were examined 1 to 7 years after surgery to know whether they had returned to their preoperative athletic activities. The age at time of surgery ranged from 16 to 36 years old. Twenty-five patients had Bankart's procedure,5 of them combined with reinforced cruciate repair, while 11 were treated with Bristow's procedure.
At fol l o w-up,14 of the 36 patients reported a decline in their athletic ability after surgery. This was true not only in contact or throwing sports but also in swimming and judo. We conclude that surgical treatment for recurrent instability of the shoulder does not warrant full recovery in sports.
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Bristow変法の長期成績
森岡 健, 土屋 弘吉, 江畑 巧
1991 年 15 巻 2 号 p.
304-307
発行日: 1991/09/01
公開日: 2012/11/20
ジャーナル
フリー
Since 1964, we have employed the modified Bristow's procedure for recurrent anterior dislocation of the shoulder joint in athletes. Our operative technique is to detach the coracoid process with its attached muscles and to fix it to the neck of the scapula with a screw.
We performed this operation on 84 joints in 83 patients whose ages ranged from 13 to 42 years.
The kinds of athletics in which dislocations occurred were vigorous sports such as basket ball, judo and rugby.
We have been able to follow-up 67 joints of 66 patients. The average of the follow-up term was 3 years and 5 months. Dislocation recurred in 3 patients, and pain on motion was experienced in 6patients. Mild limitation of external rotation was seen in 46 patients, which was 14 degrees on average compared to the intact side. Daily life and work were not disturbed for any of these patients. Thus, all returned to their original work.
Return to sports was accomplish e d by 54 patients,33 of whom played their original sport, and 21 enjoyed some other sport. However,12 patients did not return to any sports.
Among the many kinds of sports, judo, skiing, rugby, baseball and vo l l eyball were frequently participated in the original sport, and basketball and gymnastics were uncommonly enjoyed, too. Restriction of external rotation was 11 degrees on average when returning to their original sport and 22 degrees if they did not return to sports. We recognized that a remarkable limitation of external rotation prevents some athletes from returning to sports.
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丸山 公, 斉藤 勝之, 山口 真一, 佐野 精司
1991 年 15 巻 2 号 p.
308-311
発行日: 1991/09/01
公開日: 2012/11/20
ジャーナル
フリー
68 shoulders were available for retrospective follow-up. All of them were injured during sports activities and were treated between August 1975 and July 1989, with the minimal follow-up of 12months. The patients were divided into three groups; group A consisted of 13 joints on which a Boytchev's procedure was performed, group B consisted of 18 jointson which a Bristow's procedure was performed and group C on which a modified Bristow's procedure combined with the repair of an intraarticular lesion were performed.
The rate of recovery t o preinjury level were 46.2 % in group A,61.1% in group B and 86.5% in group C. Group C gained the better results with regard to overhead motion when compared to the other groups.
To get a good results is inperative to get exact information about the intraarticular lesions prior to surgery and to repair them as well as possible.
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三橋 成行, 高澤 晴夫
1991 年 15 巻 2 号 p.
312-316
発行日: 1991/09/01
公開日: 2012/11/20
ジャーナル
フリー
There are many reports concerning operations on recurrent shoulder dislocation and most have given satisfactory results.
Here the post o perative results, in sports activities were examined.
From 1983 to 1989, operations were performed by Bristow ' s procedure on 138 shoulders in 136cases.65 cases were further examined ( 59 men and 6 women ). The initial dislocation of the shoulder occurred at the average age of 18.8 years. The average period of fime between the initial dislocation and the operation was 4.6 years. The average age of those being operated on was 22.8 years. During that period, the average number of times of a shoulder dislocation was 8.2 times.
Apprehension and pain in the post operative shoulder joints disappeared. The range of motion of the shoulder was well preserved, the external rotation of the shoulder was 90°, which was only on average 8° limitation. Among the followed cases, there were 3 cases of re-dislocation,2 cases of non -union,7 cases of dinlodged screws,1 case of snapped screw and 1 case of nerve paralysis. Out of the 65 cases, rugby had the most cases with 45 cases.
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冬賀 秀一, 加藤 文雄, 千代反田 修, 柴 伸昌, 小池 諭, 佐手 達男, 林 弘道, 守屋 修二, 桂川 陽三, 澤本 温史, 塚本 ...
1991 年 15 巻 2 号 p.
317-320
発行日: 1991/09/01
公開日: 2012/11/20
ジャーナル
フリー
We have tried several operative methods for recurrent dislocation of the shoulder to return athletes to their sport. Since 1985 we have used combined Bankart-Bristow procedure on 27 patients.
We compared the results of this procedure with those of other operations which had bee n used formerly. Instability after surgery occured in 9 percent of the patients in combined Bankart-Bristow group,20 percent in the Bankart group,31 percent in the modified Bristow group, and 73 percent in the Boytchev group. Eighty percent of the athletes in combined Bankart-Bristow group could regain their preoperative athletic abilities, but only between 14 and 50 percent of the sportsmen could do so in the other groups.
We concl u de that combined Bankart-Bristow operation is the best procedure to attain good stability and to help athletes return to their sports.
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contact sportsへの復帰
広岡 淳, 脇谷 滋之, 林田 賢治, 米田 稔, 妻木 範行
1991 年 15 巻 2 号 p.
321-325
発行日: 1991/09/01
公開日: 2012/11/20
ジャーナル
フリー
In cases of recurrent aterior dislocation of the shoulder caused by contact sports, i. e. football, rugby, Judo, and wrestling, bony defects of the anterior glenoid rim and damage to the glenohumeral ligament are often obserbed. Especially, in contact sports athletes, the glenohumeral joint suffers more excessive force at the moment of its dislocation. So, a secure surgical technique which provides anterior stability of the shoulder is needed for such cases. Since 1981, we have performed Bankart's procedure augmented with a coracoid transfer on contact sports athletes with recurrent anterior dislocation of the shoulder.47 shoulders were treated using this procedure and follow-up for more than two years. The average age at surgery was 26 years ( range: 16-46 years) and the follow-up terms ranged from two to ten years, with an average of four and half years. According to the shoulder-rating system of Rowe et al., the clinical results were graded as follows: 29 excellent,14good, and 4 fair. The overall clinical results were satisfactory in 91 % of the cases. There was no recurrence, but four shoulders that were graded fair could not return to contact sports because of discomfort. With regards to the range of motion, only external rotation was ten degrees inferior to the opposite side on an average.
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加藤 貞利, 山崎 潤, 三浪 三千男
1991 年 15 巻 2 号 p.
326-328
発行日: 1991/09/01
公開日: 2012/11/20
ジャーナル
フリー
Complete dislocation of the acromioclavicular joint is a common injury in sports activites. Since the acromioclavicular joint has an important function in shoulder motion, dislocation of this joint should be reduced to its anatomical position, especially in athletes.
Since 1982, a modified Weaver's procedure without resection of the distal end of the clavicle has been performed in our hospital.23 cases injured in sports activites were operated on by modified Weaver's procedure. All the cases were male. The patients ranged in age at time of operation from 17 to 44 years with an average of 25.5 years. The period between the injury and the operation ranged from 3 days to 2 years and 1 moth with an average of 12 days.
The postoperative results were evaluated by means of K awabe's scores. Twenty patients were excellent and three were good. All the patients could participate in sports activities at follow-up time.
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庄司 豊彦, 加藤 文雄, 辻 隆晴, 阿部 康裕, 春山 廣記, 藤井 博章, 佐藤 智久, 林 弘道, 古沢 達也
1991 年 15 巻 2 号 p.
329-333
発行日: 1991/09/01
公開日: 2012/11/20
ジャーナル
フリー
Acromioclavicular dislocation occurs often in athletes engaged in contact sports. Open reduction is usually indicated for grade 3 injuries in young patients and athletes. We use a modified Phemister's procedure for acute acromioclavicular dislocations, and the Weaver's procedure for chronic dislocations.
From 1981 to 1989, we opperated on 102 athletes with acute acromioclavicular dislocations. Most of the injuries resulted from falls in judo. In this study, we have investigated and evaluated the subjective and objective recoveries in the athletic ability of the operated shoulder.
We were able to follow-up 62 patients. Their average age was 27.9 year s, and the average follow -up term was 4 years and 10 months. Subjectively, they were asked by questionnaire about: 1) pain,2) range of motion,3) functional disorders in ADL,4) return to sports,5) athletic ability. Objectively, we measured the isokinetic strength of the shoulders of 13 patients by Cybex II.
The subjective results of most of the patients were exellent or good. Forty-n i n e patients ( 80 %)were able to return to participating at the original level of their sports. Especially, in the case of judo expers,75 % of them attained a level-up in their proficiency after the procedure. The objective results showed no significant deficits in the isokinetic strength of the shoulder muscles.
Our investigation showed both the subjective and objective results to be s a t isfactory, and we believe that a modified Phemister's procedure is sufficiently effective, even for contact sports experts.
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尾崎 二郎, 冨田 恭治, 仲川 喜之, 桜井 悟良, 中垣 公男
1991 年 15 巻 2 号 p.
334-337
発行日: 1991/09/01
公開日: 2012/11/20
ジャーナル
フリー
The axillary nerve is frequently damaged and many mechanisms of the injury have been indicated, but reports on axillary neuropathy occuring in overused sports are rare. Thirty-five athletes with axillary neuropathy, who had a disability due to an overhead overused sports such as baseball, volleyball or tennis, were treated in our hospital from 1981 to 1989. All of the patients had sensory disturbances of the axillary nerve region, tenderness over the quadrilateral space and weakness of the deltoid muscle. The axillary nerve seemed to be entrapped at the quadrilateral space by the hypertrophied teres minor muscle in 17 patients. Twenty patients responded well to the conservative measures including rest, reform and injections of local anesthetic and a steroid compound. Ten patients with posterior ossifications of the glenoid were operated on. Resection of the osteophytes, combined with release of axillary nerve entrapment, restored their ability to pitch. We wish to emphasize that axillary neuropathy occurs frequently in overhead overused sports but it tends to be overlooked.
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森石 丈二, 黒田 重史, 住吉 徹是, 斎井 政憲, 李 鐘勲
1991 年 15 巻 2 号 p.
338-341
発行日: 1991/09/01
公開日: 2012/11/20
ジャーナル
フリー
Two cases of infraspinatus muscle atrophy in athletes were treated operatively. [case 1] A 21 year-old left-handed volleyball male player.
We performed a two stage-operation on his left shoulder. At first we released the suprascapular nerve ( resection of the superior transverse scapular ligament, neurolysis and partial shaving of the base of the spinoglenoid ) and two months later, we performed a repair of the rotator interval.
[case 2] A 17 year-old right-handed student pictcher.
We perfomed decompression of the suprascap u lar nerve in the same way as in case 1.
In all the operations, we found the supascapular nerve was swollen and inflamed at t h e region between the suprascapular and the spinoglenoid notch. In case 1, he was free of pain and able to resume of pitching successfully after surgery. In case 2 however, he got little relief of pain and was still weak. In his case, not only did he have suprascapular neuropathy but also disorders of the infraspinatus muscle.
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濱 弘道, 上羽 康夫, 山室 隆夫
1991 年 15 巻 2 号 p.
342-345
発行日: 1991/09/01
公開日: 2012/11/20
ジャーナル
フリー
As infraspinatus muscle atrophy in ball players is induced by suprascapular neuropathy or muscular damage, treatment has to be performed according to the pathogenesis. Definite diagnosis of suprascapular neuropathy comprises an electrophysiological verification of the neurogenic pattern and the delay of distal latency of the M-wave.
The lesion of the suprascapular ne r ve in ball players is supposed to be the spinoglenoid notch rather than the scapular notch. Decompression at the spinoglenoid notch is composed of carving the lateral edge of the base of the scapular spine by airtome. In addition, extirpation of the ganglion often seen at the spinoglenoid notch is carried out if necessary.
There is also, however, muscular damage combine d with or without suprascapular neuropathy. The tear of the insertion shoud be sutured.
On the other hand, there is no useful treatment in the case of degeneration of the muscle belly resulting from excessive eccentric contraction. A preventive scheme such as isometric muscle training should be emphasized before changing the muscle fibers, irreversibly.
Joint laxity or the tear of a neighboring muscle is secondary to i n fraspinatus muscle atrophy and should be also repaired to avoid serious dysfunction.
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