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Y. Hata, Y. Nakatsuchi, S. Saitoh, M. Hosaka, K. Kitagawa, Y. Nishimor ...
1992 Volume 16 Issue 2 Pages
195-199
Published: September 01, 1992
Released on J-STAGE: November 20, 2012
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Thirty-one shoulder joints of 19 cadavers were dissected to investigate the anatomical characteristics of the glenoid labrum. The cadavers were 13 males,4 females and 2 unspecified, with a mean age of 78.5 years ( range,63 to 90 years old ). The glenoids were cut with a bone saw in the long axis and the short axis of the glenoid surface and the sizes of the glenoids and the labra were measured with calipers.
When comparing the mean depths of the glenoids without a labrum, the mean depths of the glenoids with a labrum were increased anteriorly, posteriorly, superiorly and inferiorly. Similarly, the mean extents were increased in the long axis and in the short axis. The mean heights and the mean widths of the labra were measured from all four positions.
The widths of the anterior labra were significantly la r ger than the posterior ones ( p<0.01). The widths of the supjrior labra were significantly than the inferior ones ( p <0.01).
The acromion and the glenoid play important roles in the superior and posterior stabilization of the shoulder joint respectively. The anterior and inferior labra may contribute to the stabilizations in the anterior and inferior directions respectively. There was no significant correlation between the size of the labrum and that of the glenoid. This indicates that even if the glenoid is large, the labrum is not always correspondingly so.
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T. Tsuchimochi, T. Sasaki, M. Okada, T. Suzuki, J. Hayashi, Y. Imazato ...
1992 Volume 16 Issue 2 Pages
200-203
Published: September 01, 1992
Released on J-STAGE: November 20, 2012
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The present study was undertaken to investigate the tensile strength in the soft tissues of a normal shoulder joint.
Using an lnstron testing machine, we measured the tensile strength of the coracoacrominal ligament, membrane tissue of the rotator interval, the anterior capsule and the long head of the biceps (the tendon proper or the transitional portion from the tendon proper to the muscle of the myotendious junction or both) in 5 cases aged from 23 to 59 years old immediately after their accidental deaths.
The results of biochemical analyses showed most matured collagen fibrils in the tendon alone of the long head of the biceps and less matured from in the coracoacrominal ligament, membrane tissue of the rotator interval, the anerior capsule, and the myotendinous junction of the long head of the biceps in this descending order.
The tendon plus the my otendinous junction of the long head of the biceps had the strongest mechanical properties compared with the tendon alone or the myotendinous junction alone of the biceps: whereas the myotendinous junction of the long head of the biceps had the weakest. Streng th was the greatest in the tendon plus the myotendinous junction of the long head of the bicep s and it became weaker in the following order in the tendon alone of the long head of the biceps, the coracoacrominal ligament, the membrane tissue of the rotator interval, the anterior capsule, and themyotendinous junction of the long head of the biceps. The results of the tensile strength measurement seemed to correlate with those of our previous biochemical analyses of collagen contents in the same sites.
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M. Urakawa, A. Kawashima, Y. Kanatani, K. Nobuhara
1992 Volume 16 Issue 2 Pages
204-207
Published: September 01, 1992
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The shapes of the glenoid were analyzed in this study. The subjects were fifty healthy right shoulders of males aged between 19 and 39 years ( mean 28.1 ). They were supined on a table with their arms at a 90 degree-abducted-position, and the shape of the glenoid was photographed by rotating a fluoroscope around the humeral axis in a 180-degree-arc and recorded on a video tape three dimensionally. The relationships between the images and the angles were recorded on an NAC SELGRAPH 2D SYSTEM. Thirty six images at intervals of five degrees were sampled and each image was analyzed by a PIAS LA500 image analyzing system. Assuming that the surface of the glenoid is an ellipsoid, its approximate equations were calculated. Furthermore, the approximate equations in specific areas of the glenoid were also calculated.
The humeral head has a similar shape to a spheroid with its rotational axis on the long diameter, while no tendency was observed in the whole zone of the glenoid. However, the superior and the anteroinferior portion of the glenoid showed a similar shape to a spheroid. Moreover, the central area of the glenoid showed a larger curvature then did the other areas. This study reveals that the shape of both the superior portion of the glenoid and the humeral head have similar congruities. Actually they fit well into an arm elevated position. This suggests that this relationship is significant for getting stability of the shoulder in a joint needing support.
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G. Yoshikawa, M. Maeno, S. Fukuda, M. Murakami, M. Hata, M. Makikawa
1992 Volume 16 Issue 2 Pages
208-213
Published: September 01, 1992
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Existence of a dynamic stabilizing system of the glenohumeral joint is still controversial. According to Murakami the infraspinatus muscle works as a main stabilizer of the joint when a backward stress is loaded to the humeral head. We revealed a disorder of the infraspinatus muscle in a case of posterior subluxation of the shoulder by electrophysiological examination.
Backward stress was loaded to the humeral head of a patient with posterior subluxation of the right shoulder, while the active potentials of the infraspinatus, supraspinatus and deltoid muscles were quantitatively measured.
Electrical activdt y of the infraspinatus muscle was weaker on the affected side than on the healthy side, although no muscle atrophy was observed. The supraspinatus and deltoid behaved alike on both sides.
If the infraspinatus muscle works as a dynamic stabilizer in response to the signals arising from the sensors in the posterior capsule when it is extended, our findings are thought to show that the feedback mechanism of the joint capsule is disturbed in the subluxation of the shoulder.
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Arthrodesis Patients
K. Miura, S. Takai, K. Tamai, K. Kamada, K. Yanaga, K. Senpo, Y. Hiras ...
1992 Volume 16 Issue 2 Pages
214-217
Published: September 01, 1992
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Three-dimensional motion of the shoulder is still under debate due to its anatomical complexity. This study was designed to examine the three-dimensional motion of the shoulder by a non-invasive measuring method.
Five normal subjects and four post-arthrodesis patients with brachial plexus injuries were examined. Active arm elevation was allowed in both the sagittal and scapular planes. Eight points were marked on the skin near the spine, the sternum, the clavicle, the scapula and the humerus which were identified every 15° or 30°.
These were recorded on three VCRs. A three-dimensional analysis system (ARIEL PERFORMANCE)was employed.
For normal subjects, the relationship between the elevated angles of the scapula and those of the humerus were approximately linear with the ratio falling between 0.3 and 0.4. Three out of the four patients with shoulder arthrodesis demonstrated that the 3D-angles between the sternum and the clavicle increased similarly to those of normal subjects, but the 3D-angles between the clavicle and the scapula increased more greatly than in normal subjects,
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Y. Taketomi
1992 Volume 16 Issue 2 Pages
218-220
Published: September 01, 1992
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The purpose of this study was to examine the correlation between subluxation of the shoulder joint and the motor recovery stage in stroke patients with hemiplegia(CVA).
One hundred and two CVAs were divided into two groups according to Brunnstrom's motor recovery stage; Synergy Stage(66 subjects) and Coordinated Stage(36 others), and subluxation. The acromion elevation distance(AED) was measured by shoulder shrugging.
The synergy stage had more subluxations (89%) than did the coordinated (36%). The mean AED in synergy with and without a subluxation was 2.63 and 3.08cm, respectively. In the coordinated, the mean value with and without one indicated 4.8 and 5.39cm, respectively. The AED of both stages differed significantly, depending on whether it was or without a subluxation (p <.01).
There were no significant differences in shoulder shrugging between the with and the without a subluxation, which was considered to be muscle strength of the upper trapezius due to the static in a subluxation and the dynamics in shrugging. The restoration of the subluxation coordinated the movements between the scapular rotators and the shoulder elevators.
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Y. Tajiri, M. Takahashi, H. Sugioka, T. Hata
1992 Volume 16 Issue 2 Pages
221-224
Published: September 01, 1992
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Arthrodesis of the shoulder joint by internal fixation (Mele d' Aubign,1966) and shoulder brace immobilization used to be performed in our hospital for the reconstruction of a paralyzed joint in a brachial plexus injury. But it is uncomfortable for a patient to wear a brace for many weeks and disadvantageous to his rehabilitation.
Since April 1990, we have used a combined method of an AO screw fixation with bone grafts and an external fixation with an Ace Fischer external fixator.
13 patients with BPI were treated by this comb i n ed method. A solid bony fusion was obtained in all the cases. The duration of the exaternal fixation was 90-125 days (average 107.1 days). A superficial pin tract infection was observed in 3 cases.
The results of our combined method for should e r arthrodesis in BPIs were successful. It has some advantages, when compared with shoulder brace immobilization, which are as follows.
1. One can quickly do ROM exercises of the scapula or elbow.
2. It is hygietic in the axilla region.
3. It is easy for changing cloth e s.
4. One can sleep in a supin e position.
5. It is light in weight.
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M. Tanaka, M. Tsuchiya, K. Kubota, T. Nakagawa
1992 Volume 16 Issue 2 Pages
225-231
Published: September 01, 1992
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Stress X-p in the evaluation of the antero-posterior and inferior instabilities of the shoulder joint was examined, because the diagnosis and pathogenesis of shoulder instability have not been established.
Twenty cases (20 joints) with shoulder instability were evaluated. Their ages ranged from 14 to 38 years with an average of 23.8 years. As a control,11 normal cases (22 joints) were examined.
After checking the shoulder instability manually, we measured the anterior instability by X-p. The patients were positioned prone with their shoulder abduction at 90 degrees and neutral rotation in the scapular plane, a 5-kg weight was loaded into the humeral subcapital region. Posterior instability was examined with the patients supine. We measured the sinking rate of the head by Endoh's method. Simultaneously, we investigated the correlation between shoulder instability and ADL disturbance as well as the correlation between shoulder instability and Carter's sign.
The group with shoulder instability showed a greater displacement than did the controls.
There was no apparent correlation between a-p and inferior instability.
There was no apparent correlation between ADL disturbance a nd shoulder instability.
There was a correlation between Carter's sign and posterior instability. There was a correlation between the episodes of subluxation a nd inferior instability.
Stress X-p seems to be a useful method for evaluating shoulder instability.
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Y. Tomita, J. Ozaki
1992 Volume 16 Issue 2 Pages
232-234
Published: September 01, 1992
Released on J-STAGE: November 20, 2012
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So-called loose shoulder is an increasingly recognized clinical entity. Cineradioarthrography is useful to evaluate the state of an intracapsular lesion precisely.The purpose of this study was to review the lesion of the loose shoulder using cineradioarthrography and to define the pathology of this condition.
The series was comprised of 5 patients (3 men and 2 women) suffering from loose shoulder as diagnosed clinically. The shoulder joint was punctured under a image intensifier with the anterior approach. The needle was connected via a tube with a syringe and then 15 to 20m1 of contrast medium (mixture of 60% Urographin and 1% xylocain) was slowly injected. After accepting the medium, in order to study the appearances of he shoulder joint, the upper extremities were allowed to move multidirectionally. During such a procedure, the observations were recorded on a VHS video -tape.
The cineradioarthrographic signs were recorded as pathologic were redundancy of the joint capsule and enlargement of the rotator interval. In addition, a contrast observation was a minimal ‘to ad fro’ motion of the accepted medium.
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K. Maruyama, H. Sato, Y. Kobayashi, S. Sano, T. Matsuura, Y. Yamaguchi
1992 Volume 16 Issue 2 Pages
235-239
Published: September 01, 1992
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The method of evaluating a shoulder joint has not been established yet. In spite of this laxity, itself, is thought to be one of the major pathologies of shoulder disorders. We would like to present a new method of evaluation using arthroscopy here.
(Method) Arthroscopic examinations were performed under general anesthesia in the lateral position with the affected arm in traction. The degrees of the floating of the humeral head away from the glenoid were classified from F-O to F-4.
(Results) Joints having multidirectional instability were rated to be F-3 or F-4. There were some differences in the floating extent between the group of recurrent anterior dislocation and the group of recurrent anterior subluxation. There was a tendency that the looser joint was, the less pathological changes existed in the joint.
(Conclusion) This floating method is a relatively easy and useful one to evaluate joint laxity of the shoulder.
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H. Muratsu, Y. Itakura, K. Mizuno
1992 Volume 16 Issue 2 Pages
240-244
Published: September 01, 1992
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K. Morisawa, Y. Kataoka, M. Yamaga, T. Kitamura, K. Takagi, M. Hirano
1992 Volume 16 Issue 2 Pages
245-248
Published: September 01, 1992
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We have reported on the good results obtained from the conservative treatment of multidirectional instability of the shoulder joint. However, there have been a few cases which did not respond to this treatment. In this study, we investigated the limits of the ability of conservative treatment for multidirectional instability of the shoulder joint by comparing those cases which responded with those which did not.
We treated 44 cases (21 cases: male,23 cases: female) with multidirectional instability of the shoulder joint from November 1988 to June 1991. The initial 12 patients were treated using rotator muscular strengthening exercises, mainly. Six cases did not respond and were treated surgically.
The other 32 cases were treated using muscular strengthening exercises and a scapu l ar stabilizing band, and their results were better than those in the initial group. But, four of them had to be treated surgically.
We found a few cases did not respond to the conservative treatment. These unresponded cases had specific clinical features that were as follows.
1) severe rest pain, and numbness and/o r swelling in the hand and forearm,2) severe shoulder joint laxity, and 3) involuntary painful dislocation.
Most of the cases with multidirectiona l instability of he shoulder joint can get well by conservative treatment, but a few cases can not and need surgical treatment.
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H. Muratsu, Y. Itakura, K. Mizuno
1992 Volume 16 Issue 2 Pages
249-254
Published: September 01, 1992
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Prognostic Factor of Instability after Initial Dislocation
Y. Gotoh, Y. Watanabe, N. Mura, M. Sagae, K. Oyama, M. Endou, M. Yuki
1992 Volume 16 Issue 2 Pages
255-261
Published: September 01, 1992
Released on J-STAGE: November 20, 2012
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The purpose of this study is to know the frequency and the prog n ostic factors of instability after the initial dislocation of a shoulder. (Materials and Methods) From December 1985 to March 1991,297cases with anterior dislocation of the shoulder while skiing were treated initially at Zao Hospital. There were 226 men and 71 women, and their age at the time of dislocation averaged 25.9 years (range,14 to 66 years). Questionnaires were sent to all of them. We statistically studied the prognostic factors of instability on the basis of these questionnaires.
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R. Nakamura, S. Harata, S. Toh, Y. Okamura, [in Japanese]
1992 Volume 16 Issue 2 Pages
262-266
Published: September 01, 1992
Released on J-STAGE: November 20, 2012
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In order to asses the accuracy of MRI findings in relation to glenoid labral lesions and rotator interval tears, we compared MRI findings and the observations of doctors during actual surgery.
30 shoulders were evaluated for lesions of the glenoid labrum. The diagnosis were: r ecurrent anterior dislocation in 18 shoulders, sports injuries in 7 shoulders and others in 5 shoulders. All were later treated surgically. In 22 of the 30 shoulders, MRinages were evaluated for the diagnosis of rotator interval tears. MRI was performed with superconduction units.
The criter on for a normal glenoid labrum on MRI was a well-defined, wedge shaped structure of low signal intensity adjacent to the glenoid rim. When an increased intensity was seen within the labrum or its margin was absent in the labral structure, we diagnosed it as an abnormal glenoid labrum. At operation, Bankart's lesions were seen in 19 of the 30 shoulders, glenoid labral tears in 4 shoulders and normal labral in 7 shoulders. There were 2 false-negative diagnoses and one falsepositive one on MRI. The sensitivity and specificty of MRI in the diagnoses of glenoid labral lesions were 91.3 and 85.7 per cent.
Rotator interval tears could also be diagnosed on MRI, showing as a large opening of high intensity between the supraspinatus and subscapularis tendons.
MRI is very useful in the diagnosis of traumatic an t erior or inferior instability of shoulders.
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H. Kumagai, M. Mikasa, T. Ishibashi
1992 Volume 16 Issue 2 Pages
267-271
Published: September 01, 1992
Released on J-STAGE: November 20, 2012
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Seventeen patients with recurrent anterior dislocation of the shoulder underwent MR imaging with and without an intraarticular Gd-DTPA. Surgical findings of the anterior glenoid labrum were available for all the patients. Defects of the anterior labrum were diagnosed with the MR images in eight patients. Surgery proved the defects in seven of the eight and a detachment in the other one. Detachment of the labrum was diagnosed with the MR images in five of the 17. Surgery proved detachment in four of the five, and no tears in the other one. No tears were diagnosed in the other four of the 17. Sugery proved no tears in the four. Consequently we could correctly diagnose labral tears in 16 of the 17 patients. Labral tears were diagnosed mainly on T1-weighted images with a Gd -DTPA. T1-weighted images without a Gd-DTPA showed increased signal band in the anterior labrum even in patients without labral tears. MR images with a Gd-DTPA seem to be a useful method for evaluating the glenoid labrum.
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M. Horii, T. Kubo, M. Terawaki, C. Shimizu, M. Kurokawa, Y. Hirasawa
1992 Volume 16 Issue 2 Pages
272-276
Published: September 01, 1992
Released on J-STAGE: November 20, 2012
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Our previous studies have shown that MRI is extremely useful for evaluating a shoulder experiencing recurrent anterior dislocation. But capsular stripping and displacement of a torn labrum are difficult to detect. We investigated the ability of a joint fluid (the effusion, of ten patients with a recent dislocation or by injecting physiologic saline, in six patients) to enhance the detection of these abnormalities. T2*-weighted images with field gradient echo sequences were obtained using either a 1.0 or 1.5 tesla superconductive MRI system (Shimadzu).
The joint fluid enhanced well in all cases.The labr a l abnormalities which we observed included decreased size (five cases), detachment (two cases) and both (two cases). Capsular stripping was observed in all cases, except a 40-year-old woman studied after her first dislocation. Fracture of the glenoid rim was observed clearly in one case. The Hill-Sachs lesion was detected in all shoulders.
These results show that a joint effusion can serve as a natural, noninvasive contrast m a terial in acute cases, and that physiologic saline is the safest and most economic contrast material in chronic cases. Shoulder joint fluid facilitates the detection of labral changes and capsular stripping after anterior dislocation on T2*-weighted MR images.
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K. Takagishi, A. Nishimura, M. Itoman, T. Araki, T. Ikeda
1992 Volume 16 Issue 2 Pages
277-279
Published: September 01, 1992
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Instability of the glenohumeral joint is divided into two subgroups, traumatic and non-traumatic. The purpose of this study is to show the differences on MR imaging between recurrent dislocation of the shoulder joint and non-traumatic shoulder instability.19 patients with recurrent anterior dislocation of the shoulder and 20 patients with non-traumatic shoulder instability' including multidirectional instability and voluntary instability were examined.20 patients underwent operations. In the group of recurrent dislocation, labrum damage was observed in 17 and Hill-Sachs defect in 17. But stripping of the joint capsule from the bony glenoid was not observed. Similar results as these were obtained by those of arthro CT and confirmed surgically. In the cases of non-traumatic shoulder instability, the tip of the labrum sometimes became dull. A few of the patients had abnormalities in the rotator interval and posterior part of the glenoid. MRI demonstrated that Bankart's lesion and Hill-Sachs defect are typical findings of recurrent anterior dislocation but no typical findings exist for non-traumatic instability.
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H. Shibuta, K. Yoshida, H. Katumoto, K. Tamai
1992 Volume 16 Issue 2 Pages
280-283
Published: September 01, 1992
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Recently MR imaging of the shoulder has come to our notice as being noninvasive and accurate. With the purpose of evaluating its diagnostic values detecting the pathology of an unstable shoulder MRI was performed on recurrent anterior dislocations of the shoulder, which were compared with their CT arthrographs and the MRIs of stable shoulders.
Sixteen patients with recurrent anterior dis location of the shoulder (average age 24.6) were assessed using Ti weighted axial images obtained from a Diasonics 0.064 Tesla permanent magnet system. Twelve of these patients were concomitantly examined by CT arthrography (CTA). In addition, the MR images of 10 shoulders without instability (average age 23.5) were chosen to serve as the control.
The control images did not show any significant abnormalities, although a mild rounding of the glenoid labrum was seen in 3 shoulders. By contrast,8 disapearances,6 decreases in size and roundings, and 2 roundings were found in the unstable shoulders. But the two roundings of the labrum in the unstable shoulders seemed to be the same as a shoulder without instability.
The CTA findings of the labrum were almost the same as the MR images. Furthermore, CT arthography disclosed a detachment of the anterior capsule which was not detected by the MRI.
Conclusion: Although almost MRI was a useful method for a recurrent anterior dislocation of the shoulder, CT arthrography was superior to MRI in detecting changes of the anterior capsular mechanism.
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T. Fujiwara, M. Kawabata
1992 Volume 16 Issue 2 Pages
284-287
Published: September 01, 1992
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There are two distinct types of causative injuries of anterior subluxation of the shoulder. One is excessive repetitive abduction and external roration of the shoulder as when serving in tennis or pitching (groupA). The other is a direct blow or forceful hyperextension of the arm (groupB). There are two subgroups of group B. Group B-1 is the initial injury was a traumatic anterior dislocation, followed by recurrent anterior subluxation. Group B-2 is the other subgroup.
In group B-2, most of the patients had experienced a direct blow on the shoulder. So because of a swelling and severe pain, anterior subuxation of the shoulder is difficult to identify and frequently misdiagnosed in the early stages of the initial trauma in group B-2.
We have treated 29 cases suffering from recurrent anterior s u bluxation of the shoulder over the past five years. Six patients were group A,6 were group B-1 and 17 were group B-2. All the cases had complained of a “dead arm” when the arm was in the elevated position with external rotation, and had a positive anterior apprehension sign.
In group B-2,4 patients had had a“slip out” sensation of the shoulder when the subluxation recurred.
A diagnosis of sprain or of contusion was made in 11 patients who had had no“slip out” sensation of the shoulder. All the patients were positive in the anterior apprehension test.In this test we objectively recognized their humeral heads slipping out with a click in 5 cases. But we could not perform this test on some cases of groupB-2 due to severe pain and swelling in the early stages of the initial trauma.
Arthrog r aphy and computed arthrotomography were useful in demonstrating the detachment of the anterior labrum and capsule from the glenoid rim and redundant capsule.
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Comparisons with The Normal Sides
S. Koike, F. Kato, H. Hayashi, H. Toga, Y. Abe, Y. Sekiguchi, T. Shoji ...
1992 Volume 16 Issue 2 Pages
288-293
Published: September 01, 1992
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We performed preoperative CT arthrography on bilateral shoulders of 26 patients who had a recurrent dislocation on only one side. In assessing the CT arthrograms, We compared our findings in the unstable shoulder with those in the normal shoulder. When the CT scan was done in external rotat i o n, the anterior joint capsule was tight in the normal shoulders, while it was lax in 15 out of 18 unstable shoulders.
When the CT scan was done in the neutral position or internal rotation, the capsule was lax on both sides in all cases. However, the degree of laxity was more evident on the unstable side in 7 out of 8 shoulders.
The patterns of the attachment of the joint capsule were variable in th e normal shoulders; Type 1 in 18, Type 2 in 6, and Type 3 in 2, according to Rothman's classification. In the unstable shoulders, detachment of the capsule was suspected in 20 out of the 26 cases, but only 12 joints were judged to have an actual detachment when compared with the normal side.
The changes of the glenoid labrum agreed with the operat i ve findings in most cases. However, there were 6 abnormal labra on the normal side; 4 undeveloped,1 deformed, and 1 torn. In all of these cases, the labrum had disappeared in the unstable side.
We concluded that preoperative CT arthrograp h y performed on bilateral shoulders provided useful information on the nature of the pathology of an unstable joint.
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K. Matsui, K. Ogawa
1992 Volume 16 Issue 2 Pages
294-298
Published: September 01, 1992
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Since 1983, we have operated on 77 shoulders with anterior instability after pneumoarthrocomputed tomography to treat recurrent anterior subluxation (luxation) and dead arm syndrome, and 73 shoulders that basically had multidirectional instability we compared the results of this method with the operative findings to determine the accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of this method with regard to the following features: Hill-Sachs lesions, the labral lesions, so-called osseous Bankart lesions, periosteal reaction or bony proliferation, loose bodies.
An accu r acy of 90-100% was attained in Hill-Sachs lesions, osseous Bankart lesions, and loose bodies. For the labrum, typical Bankart lesions (detachment and defects) were detected at an accuracy of 99%, while the positive predictive value for cracking and deformation was 36% and 71%, respectively.
The most important findings for the diagnosis of recurrent anterior subluxation (luxation) are Hill-Sachs lesions and the typical Bankart lesions.
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S. Kuroda, T. Sumiyoshi, M. Sai, J. Moriishi, Zhong-Xun Li
1992 Volume 16 Issue 2 Pages
299-303
Published: September 01, 1992
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In some cases, the differential diagnosis between traumatic shoulder instability and atraumatic shoulder instability is difficult. The diagnostic value of physical signs, plain X-rays, arthrographies and CT scans of 431 shoulders in 311 cases of traumatic and atraumatic shoulder instabilities was investigated. In 27% of the traumatic shoulder instabilities, two or more of the following instabilities were recognized downward, backward and forward instability and increased rotatory motion of the shoulder joint in the zero-position. They. were recognized in 98.6% of the atraumatic shoulder instabilities. However, in cases of traumatic shoulder instability, Hill-Sachs lesion was recognized in 86.1%, Bankart lesion was in 42.8% and subscapular leakage was in 50%. But they were not recognized in cases of atraumatic shoulder instability. Outward slipping of the humerus on plain X -rays taken in the zero-position was recognized in 13.1% of traumatic shoulder instability and 87.1%of atraumatic shoulder instability. The ski cap finding was recognized in 22.6% of the traumatic shoulder instabilies and in 96.7% of atraumatic shoulder instabilities. In CT scans, hypoplasia of the glenoid was recognized in 6.1% of traumatic shoulder instabilities and 86.7% of atraumatic shoulder instabilities. The posterior opening angle of the glenohumeral joint was 15.3° ±4.3(mean±standard deviation)in traumatic shoulder instability and 20.3±4.0 in atraumatic shoulder instability. Correct evaluation of a shoulder joint instability is indispensable condition for a differential diagnosis between traumatic and atraumatic shoulder instabilities. Hill-Sachs lesion was the most valuable finding for the differential diagnosis of these disorders.
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H. Hirose, E. Fujimaki, T. Katagiri, T. Ogawa, H. Itokawa, Y. Yamamoto
1992 Volume 16 Issue 2 Pages
304-309
Published: September 01, 1992
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We studied the clinical significances of l3ankart's lesions of traumatic initial anterior dislocations and anterior recurrent dislocations by CT arthrograms and arthroscopic examinations.
The materials consisted of initial dislocations (I-D) 22 cases, recurrent dis locations (R-D) 46cases, CT arthrographies (CAT) 68 cases and arthroscopic examinations (AS) 11 cases. According to the CTA classification of Ishikawa, observational levels were made in the midline and inferior 1/4of the anterior glenoid.
Arthroscopic investigatious were made as to the extent of the labrum injury, the damage of midline and inferior gleno-humeral ligamentum. I-D findings and R-D findings were compared with the AS and CTAs.
Results and conclusion: In the I-D group, type III or more was found in 12 cases (50.0%) in the midline, inferior 1/4 level. In the R-D group, type III or more was found in 35 Cases (79.5%) in the midline and 38 cases (86.4%) in the inferior 1/4 level. The damage was heavier in the latter group compared with the I-D. The CTAs and AS correlated well when concerned with the damage of the labrum.
As CTA reflects the damage on the anterior labrum, it was considered a useful means of examination for the prognosis and for deciding on the treatment.
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Is It Possible to Predict by CT Arthrography before Arthroscopy?
N. Tsumaki, M. Yoneda, K. Okamura, A. Hirooka, K. Hayashida, T. Tomita
1992 Volume 16 Issue 2 Pages
310-315
Published: September 01, 1992
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In 1989, we proposed an arthroscopic classification for Bankart lesions. This classification is useful for the selection of a surgical technique for treating traumatic anterior shoulder instability. We studied whether it was possible to predict the type of lesion by CT arthrography before arthroscopy. Bankart lesions of 85 shoulder joints were arthroscopically classified as follows: type 1; labral detachment with a well-developed anterior inferior glenohumeral ligament (AIGHL) (27cases), type 2; labral detachment with a poorly-developed AIGHL (21 cases), type 3; ligamentous avulsion with a retracted AIGHL (22 cases), type 4; ligamentous disruption with an osseous defect (6 cases), and type 5; no Bankart lesion with a stretched AIGHL (9 cases). The discrimination of these five types was analyzed in terms of the CT arthrographic findings on bilateral shoulder joints using the quantification theory of Hayashi. CT arthrographic findings predominantly present in each type were minimal labral wear(types 1,2,5) a high attachment of AIGHL to the glenoid rim (type 1), a low attachment(type 2), a lax AIGHL(type 2), no Hill-Sachs lesions(type 5), a worn out labrum(type 3), and severe labral wear and a bony defect(type 4). The accuracy of the diagnosis from the CT arthrography was as follows: type 1(75.0%), type 2(73.8%), type 3(77.4%), type 4(96.4%), and type 5(85.7%), Thus, our five arthroscopic types of Bankart lesions can be discriminated by CT arthroscopic findings prior to arthroscopy.
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Findings of Inferior Glenohumeral Ligament-Labrum Complex
K. Midorikawa, M. Takeshita, Y. Shibata, T. Izaki, M. Hara
1992 Volume 16 Issue 2 Pages
316-321
Published: September 01, 1992
Released on J-STAGE: November 20, 2012
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Arthroscopic examinations were performed on 60 cases of recurrent dislocation of the shoulder. We classified the arthroscopic findings of the inferior glenohumeral ligamentlabrum complex(abbreviated as IGHLLC) into 3 types(type A, B and c). The purpose of this study is to catch the possibility for arthroscopic repair of IGHLLC.
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O. Shigemori, R. Yamamoto, I. Anraku, K. Mihara, Y. Imazato, S. Hokari ...
1992 Volume 16 Issue 2 Pages
322-325
Published: September 01, 1992
Released on J-STAGE: November 20, 2012
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Arthroscopic examinations of the gleno-humeral joints were performed on 33 recurrent anterior subluxations. We observed the long head of the biceps, the rotator cuff, the head of the humerus, the glenoid and the glenoid labrum by posterior approach.
Changes of the long head of the biceps s uch as tenosynovitis, fibrillation and partial tendon rupture were observed in many cases. Synovial bands across the tendon were seen in 8 cases (24.2%). Changes in the rotator cuff such as fibrillation, synovial proliferation and joint side cuff tear were seen in 30.3% cases.87.9% cases had diffuse postero-lateral notches. We observed detachment and absence of an antero-inferior labrum in 84.8% cases. In addition, we observed detachment of the antero-middle labrum in 45.5%, detachment of the antero-superior labrum in 42.4%, and detachment of the superior labrum in 35.7% cases.
We conclude that recurrent an terior subluxation brings extensive changes to the gleno-humeral joint and that arthroscopic findings of a subluxation are slightly different from those of a dislocation.
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Instability in Sports Activities
Y. Hara, T. Nakamoto, T. Suzuki, T. Hayashi, K. Hirohashi
1992 Volume 16 Issue 2 Pages
326-329
Published: September 01, 1992
Released on J-STAGE: November 20, 2012
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Pathologic conditions are complicated in some patients with traumatic shoulder instability. Especially when treating a dominant arm in sports, you have to find a method which will be efficacious in terms of its pathology and at the same time minimally invasive. Believing that arthroscopic assessment and appropriate arthroscopic surgery would be close to ideal, we have been performing this procedure.
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Stapling and Caspari's Multiple Sutures
M. Yoneda, K. Okamura, A. Hirooka, K. Hayashida, N. Tsumaki, K. Shino
1992 Volume 16 Issue 2 Pages
330-334
Published: September 01, 1992
Released on J-STAGE: November 20, 2012
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The purpose of this study was to clarify the effects of arthroscopic Bankart repairs by stapling and Caspari's multiple sutures (CMS).
Forty-eight shoulder joints i n 48 patients composed of 22 cases of traumatic recurrent anterior dislocation and 26 cases of subluxation were examined. Stapling was performed on 33 joints and CMS on 15. The mean follow-up periods were 34 months and 19 months, respectively. A sulcus sign was found in 15% of the staple group and in 30% of the CMS group.
According to our arthroscopic classifications of Bankar t lesions, Type 1(detached labrum/well GHL) was the most common in the staple group and Type 2(detached labrum/poor GHL) was the most common in the CMS. The overall clinical results were satisfactory in 82 % of the staple group and in 73% of the CMS based on Rowe's criteria.Complications included 2 staple impingements and 2 cases of suprascapular nerve damage.
Capsulorrhaphy can be perf o rmed more safely and easily by CMS than by stapling. However, there are some limitations to capsulorrhaphy for patients with a high degree of joint laxity even when using CMS, which has some disadvantages such as an unreliable suture anchoring over the infraspinatous fascia and damage to the suprascapular nerve.
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H. Sano, S. Tabata, E. Itoi
1992 Volume 16 Issue 2 Pages
335-338
Published: September 01, 1992
Released on J-STAGE: November 20, 2012
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-Iwahara-Yamamoto Method for Recurrent Anterior Subluxation of the Shoulder Joint
H. Uesato, R. Yamamoto, I. Anraku, K. Mihara, Y. Imazato, S. Hokari, K ...
1992 Volume 16 Issue 2 Pages
339-342
Published: September 01, 1992
Released on J-STAGE: November 20, 2012
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We have performed the modified Oudard-Iwahara-Yamamoto method ( modified O-I-Y) for these cases with not only recurrent anterior dislocation but also recurrent anterior subluxation since 1976. We will present the clinical results of the modified-O-I-Y for the cases with recurrent anterior subluxation.
59 shoulders in 58 cases with recurrent anterior subluxation were examined the Age ranged from 13 to 59 years old, and averaged 22.7. we mainly investigated their arthroscopic findings, postoperative recurrences, and complaints. They all had various diffuse lesions in their joints. Only one case subluxed after the operation. All the cases except one were negative in the anterior apprehension test. The clinical results were the same for both recurrent anterior dislocations and subluxations with intensive instability. Our investigations confirmed that the modified O-I-Y should become a dynamic stabilizing mechanism for cases with anterior instability such as recurrent anterior subluxation.
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T. Nakagawa, M. Ishizuki, S. Ito, K. Furuya, S. Sakano, I. Sugawa, M. ...
1992 Volume 16 Issue 2 Pages
343-347
Published: September 01, 1992
Released on J-STAGE: November 20, 2012
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We have been performing modified Bristow's procedures for recurrent anterior shoulder dislocation and subluxation since 1970. This study is an evaluation of our experiences with this procedure. Eighty-three patients (86 shoulders) were able to return for a clinical examination. Sixty-one shoulders had had recurrent dislocations and twenty-five shoulders had had recurrent subluxations. The evaluation included a questionnaire, clinical examination and roentgenograms. The mean observation time was 5 years and 6 months (range,6 months-20 years). At follow-up, one shoulder (1%) had redislocated. Another seven shoulders (8%) had had a subluxation. Five of the seven patients had had only one episode of subluxation. The preopertive apprehension sign was positive in 83 shoulders (97%).
At follow-up, the apprehension sign was positive in 23 shoulders (27%). Inferior instability was found in 33 shoulders (38%). The extent of the postoperative inferior instability with downward traction test was almost the same as the preoperative one. There was no correlation between the postoperative apprehension sign and inferior instability. The inferior instability did not influence the results of Rowe's evaluation. The limitation of external rotation compared with the unoperated side averaged 21 degrees in adduction and 17degrees at 90 degrees abduction. The limitation of internal rotation averaged 11 degrees at 90 degrees abduction.
We concluded that this procedure obtains good results even in those patients with an inferior instability.
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M. Kurokawa, Y. Hirasawa, M. Horii, K. Yanaga, K. Senpo, T. Kusakabe, ...
1992 Volume 16 Issue 2 Pages
348-351
Published: September 01, 1992
Released on J-STAGE: November 20, 2012
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The efficacy and problems of a modified Bristow operation in the treatment of recurrent dislocation of the shoulder were studied.
The study included 63 cases ( 64 joints) of recurrent dislocation or subluxation of the shoulder. These cases were followed up for one year or more after a modified Bristow operation. There were 8 females and 55 males, with their ages ranging from 14 to 56 years (mean: 20.8 years). They were divided into two groups: Group A (23 patients who received repair of the articular capsule simultaneously with a transfer of the coracoid process to the anterior acetabular edge) and Group B (41patients without repair of the articular capsule). Therapeutic efficacy was evaluated according to the scoring system for assessing therapeutic results in shoulder joint diseases established by the Japanese Orthopaedic Association (JOA score). The following 4 problems were additionally analyzed.
After the operation, the mean JOA score was 93.9, and no patient showed r e currence of a dislocation, exept for two in whom a subluxation occurred after the operation. Anxiety about dislocation persisted in 14 patients (21.8%). The percentage of patients anxious about a dislocation was slightly higher in Group B (26.8%) than in Group A (13.0%). The restriction of external rotation on the operated side was about 23.5% of that on the healthy side. Muscle power for internal rotation fell to about 60% of the preoperative level three months after the operation but rose to the preoperative level 6 months after the operation. Ten cases had complications (screw loosening in 5cases, screw damage in 2, non-union in 2 and infection in 1).
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M. Kamihira, T. Kutsuma, T. Tsuchiya, R. Matsue, I. Minai, Y. Nakatsuc ...
1992 Volume 16 Issue 2 Pages
352-357
Published: September 01, 1992
Released on J-STAGE: November 20, 2012
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We compared and reviewed the results of 2 operative procedures (modified Bristow's and Boytchev's) for recurrent anterior dislocation and subluxation. From 1975 to 1991, we operated on 55 shoulders with anterior dislocation and subluxation in our hospital and in Shinshu University Hospital (30 modified Bristow's procedure and 25 Boytchev's procedure).
We reviewed 43 shoulder joints (modified Bristow's procedure; 19 shoulders, Boytchev's procedure; 24 shoulders). The follow-up period ranged from 7 to 241 months in modified Bristow's procedure (average; 75 months) and from 6 to 145 months in Boytchev's procedure (average; 78months).
4 subluxations (16.7%) were found postoperatively after Boytchev's procedure. There were 10cases (41.7%) of nerve palsy and 3 of complete musculocutaneous palsy. No re-dislcation or nerve palsy were found in modified Bristow's procedure.
We frequently had complications wi t h Boytchev's procedure. Modified Bristow's procedure is more effective for hard workers and competitive sportsmen.
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Y. Shibata, M. Takeshita, K. Midorikawa, T. Izaki, H. Takagishi, Y. Uc ...
1992 Volume 16 Issue 2 Pages
358-362
Published: September 01, 1992
Released on J-STAGE: November 20, 2012
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We investigated the rate of return to sports activities after Boytchev's procedure.
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E. Shimozaki, H. Itokawa, T. Itoh, K. Kitaoka, T. Kobayashi, K. Tomita
1992 Volume 16 Issue 2 Pages
363-366
Published: September 01, 1992
Released on J-STAGE: November 20, 2012
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The purpose of this report is to assess the results of modified inferior capsular shift on thirteen shoulders with recurrent anterior dislocations and six shoulders with recurrent anterior subluxations. Twelve of these shoulders not only had an anterior instability but also an inferior instability. Seven only had an anterior instability, but six had large Bankart's lesions and another one had an apprehensive symptom with a slight abduction and external rotation. A modified inferior capsular shift was performed on seventeen shoulders, and a modified inferior capsular shift with a modified Bristow procedure on two. These shoulders were followed-up for 8 to 51 months (average,19.3months). The results were evaluated on the evidence of instability, significant pain, range of motion and return to sports.
There were no redislocations or significant pain, and either the anterior or inferior instability was controlled by follow-up time. Also, the results were satisfactory regarding the range of motion and the return to sports.
In conclusion, it seems that a modified inferior capsular shift, which can repair a Bankart's lesion and control instability, gives good results for shoulders which have anterior instability with or without inferior instability.
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J. Fabis, H. Zwierzchowski
1992 Volume 16 Issue 2 Pages
367-371
Published: September 01, 1992
Released on J-STAGE: November 20, 2012
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This paper attempts to explain the role of the bone graft in anterior recurrent shoulder dislocation on the basis of postoperative CT and usg examination performed on 7 patients, on whom Oudard-Sowinski's procedure was applied. As it was shown the bone graft despite of its partial resorption deepens natural glenoid at the front and creates mechanical bar for humeral head. Moreover, it enhances both tone of subscapularis muscle and tension of joint capsule thanks to their compression to the anterior glenoid rim. Disclosed in usg examination small adhesions between bone graft and subscapularis tendon did not have any important meaning for anterior shoulder stability.
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