[Purpose]The purpose of this study was to evaluate the healing ability of incomplete-thickness cuff tears. [Materials & methods] Ten torn supraspinatus tendons were obtained during operations, which were 3 bursal-side,3 intratendinous and 4 joint-side cuff tears. These specimens were fixed in 10%buffered formalin and embedded in paraffin. The digoxigenin-labeled oligonucleotide probe (22mer), which was specific to human procollagen α1 type I mRNA, was used in our in situ hybridization protocols. [Results] The signals of procollagen α1 type I mRNA were detected in the tenocytes and undifferentiated mesenchymal cells of or in the vicinity of the stumps of the torn supraspinatus tendons, but not in the fibroblasts of the subacromial bursa. They were scarcely observed in the specimens without apparent trauma. [Conclusion] Signals were detected in 8 cases out of 10 incomplete-thickness tears. Even in the longstanding tears, the signals were detected. An intratendinous tearing is supposed to extend. Spontaneous tendon healing is considered unlikely in the incomplete-thickness cuff tears.
The purpose of this study is to analyse the muscle function in the shoulder girdle, especially in the trapezius muscle with IEMG.10 shoulders with dysfunction of the scapulo - thoracic joint were studied. The upper, middle, and lower fiber of the trapezius muscle were examined using a surface EMG, and they were estimated with IEMG. They were examined with several degree of weight loading in the position of 45degrees elevation in the scapula plane. As a control,10 normal joints were used. The balanced activity of each fiber of the trapezius muscle was shown in 10 normal joints and 3abnormal joints.5 out of 8 cases showed significant activity of the lower fiber compared to the other fibers. The upward rotation of the scapula during elevation of the arm functioned because of the activity of the trapezius muscle. The significant activity of the lower fiber of the trapezius compared to other fibers seems to be the key when considering the pathogenesis of scapulo - tholacic dysfunction.
A case Report An eighteen-year-old man was injured while playing rugby. He tackled and fell. His left scapula was hit hard on the ground. He started to feel pain along the medial edge of the left scapula and could not elevate his left arm over head. He showed a characteristic posture. His left scapula shifted upper and rotated laterally. When he tried to move his left scapula medially, he felt such strong pain that he could not move. There was no abnormality of the left shoulder joint or rotator cuff. A radiogram showed the same displacement of the left scapula. No cuff tear or rupture of the muscle ware on the ultrasonography, CT or MRI. On the electromyogram two weeks later, the left rhomboid muscles showed a low voltage and the trapezius was normal. Conservative treatment by clavicular band relieved the pain. After one month, his scapula was winging. He only could not move his left scapula medially. He started muscle exercises of the scapula to adduction. He took six months to recover full power of his rhomboid muscles. After ten months, the symptoms were completely relieved. It seems that such cases caused by traction or compression injury of the dorsal scapular nerve in sports is quite rare as is a traumatic acute paralysis of the nerve.
We will report on a case of posterior fracture-dislocation of the shoulder joint with a rare fracture fragment. Involved in an automobile accident in September 1992, a 20-year-old man was taken to hospital. A diagnosis of a posterior fracture-dislocation of the shoulder joint was confirmed by X-ray examination, and the dislocation was reduced under general anesthesia. On admission to our hospital, the X- rays showed a bone defect of the greater tuberosity of the humerus. The CTs showed a fracture fragment involving the greater and the lesser tuberosity and the bicipital groove. We operated on him 3 weeks after his injury. At that time, the long head tendon of the m. biceps was put out of the bicipital groove, and the fracture fragment was reduced easily, and the fragment was fixed by figure-eight wiring. At follow-up 2 years later, he had full range of motion, no instability and no complaints. In general, acute fracture-dislocation of the shoulder joint reposition a bone fragment after reduction of the dislocation well. But in this case the bone fragment was not reduced after reduction. We consider that the bone fragment had been pulled by the long head tendon of the m. biceps and displaced to the inferomedial position.
We designed a new arthroscopic classification for Bankart lesions, and compared the arthroscopic findings with a group of initial dislocations (Group ID) and that of recurrent dislocations (Group RD) using this classification.67 shoulders in 65 patients were evaluated using arthroscopy. There were 22 shoulders in Group ID and 45 shoulders in Group RD. We classified Bankart lesions as follows: Type 1 had a well preserved AIGHL/labrum complex, AIGHL and MGHL. Type 2 had preserved AIGHL / labrum complex, and atrophic MGHL. Type 3 had a destroyed AIGHL / labrum complex and remained MGHL. Type 4 had a destroyed AIGHL /labrum complex and no MGHL. In addition, two subtypes were designed for each of Type 2,3 and 4. Type “a” had an atrophic AIGHL and Type “n” had a normal AIGHL.27.6% of Group RD had Type 1.31.8% of Group ID and 17.8% of Group RD had Type 2n.4.5% of Group ID and 20.0% of Group RD had Type 2a.27.6% of Group ID and none of Group ID and 26.7% of Group RD had Type 3n.4.5% of Group ID,2.2% of Group RD had Type 3a Neither Group had Type 4n.4.5% of Group ID,33.3% of Group RD had Type 4a. These suggest that, when the initial dislocation advances to a recurrent dislocation, the AIGHL / labrum complex is ruined in Type 1 and Type 2n, but the ligaments are ruined in Type 3.
A short term result of arthroscopic Bnkart repair with Grasping stitcher system was evaluated in this report. Thirty-five patients of recurrent anterior dislocations or subluxations.21 males and 14 females, aged from 14 to 50 (average 23 years old) were treated arthroscopically with Grasping stitcher system. The candidates of this technique were limited to patients which 1) had identified inferior glenohumeral ligaments during surgeries,2) had no large osseous Bankart lesions,3) were not involved in high level contact sports activities. The transglenoid sutureswere performed with modified Grasping stitcher in recent cases, intended not to damage the glenohumeral ligament labral complex. Twenty-three patients, followed more than 6 months, were evoluated clinicaly by Carter Rowe's criteria. Tweleve (52.5%) were exellent,8 (34.8%) were good,2 (8.7%) were fair, and 1 (4.3%)was poor. Redislocation occurred in one case and three cases had residual shoulder pain. The mean restriction of limitation of external rotation was 6.6 degrees at follow up of one year and two months in average after surgeries. CT-Arthrography at more than 3 months after operations revealed well reconstructed ligament labral complex. This arthroscopic Bankart technique is reliable for the recurrent anterior instabilities under the careful considerations of the indications.
We will present the study of the surgical treatment (the functional reconstruction used by multiple muscle transfers) of birth palsy. Eight shoulders with birth palsy were treated from 1988 to 1993. There were three boys and five girls. Five were right side and three were left. Two were latissimus dorsi (LD) transfers only, three were trapezius (Tr. ) transfers only and Three were both latissimus dorsi and trapezius (LD+Tr.) transfers. The average age at surgery was 9 years and 11months and the postoperative period was 1 year and 9 months. The results of the LD transfers for posterior dislocations or internal rotational contractures were good. Two cases on whom only Tr. transfers had been performed had fair results because of weak LD muscle strength. Cases with a deltoid MMT 3 on whom LD+Tr. transfers had been performed had good results. A case with deltoid MMT 1, however, recovered with under 90 degrees in shoulder abduction. Fortunately, this case had a stable shoulder running without any need for a support.
(Purpose) The purpose of this study is to report on the results of those patients who underwent surgical treatment for a superior labral tear which occurred without a shoulder dislocation. (Material and Method) From 1990 to 1994, we performed arthroscopy first and then surgically on 19 patients with a superior labral tear of the shoulder. Sixteen of them suffered during sport's activities. The chief complaints were shoulder pain, loss of ROM and a subluxation feeling. They had tenderness in their anterior shoulders and the symptoms were evoked when in the throwing position. Arthroscopic surgery was performed on 12 patients and open surgery was performed in 7patients. The average follow-up period was 10.1 months. The results were compared before and after surgery according to the shoulder criteria of the Japan Shoulder Society. (Results) Patients were classified by Snyder's classification. They were type 1 or type 2, but we were unable to classify 7 patients. All the patients who's labral tear was from the superior to the inferior had a subluxation feeling. The average points before and after arthroscopic surgery were 79.1 points, and 87.8 points and before and after open surgery were 73.9 points, and 90.8 points, respectively. (Conclusion) Most labral tears without a dislocation of the shoulder are caused during a sports activity. An inferior labral tear seems to always cause instability. The question is when should we let the patients go back to sports after surgery.
We studied the postoperative poor results of rotator cuff ruptures. Operations were performed on 25 patients (25 shoulders). The age of 21 men and 4 women ranged from 26 to 77 years (mean: 57.9 years). The postoperative follow-up period averaged 32.6months (range 6-77 months). There were one small tear,11 medium,5 large and 7 massive tears. The operative procedures were 15 McLaughlin methods,3 Takagishi,4 side to side and 3 end to end sutures. At follow-up, the people who had under 15 points of pain in the JOA score or could not elevate their arm over 90° were estimated as poor. At follow-up, we had 6 poor results which included 4 cases of massive tears. Two cases had reoperations because of postoperative abduction contracture and rerupture of the repaired rotator cuff. One was a rotator cuff release operation, and the other was a latissimus dorsi transfer. In the two poor results of medium tears, their causes were a fatty degeneration of the supraspinatus and a preoperative osteoarthritic change of the humeral head. Besides the afore-mentioned cases, we must report on two cases of glenohumeral osteoarthritic changes after rotator cuff sutures. One case was a 26-year-old man and the other was a 35-year-old woman. They had medium tears of the supraspinatus tendons on which we performed McLaughlin method or end to end suture. They had an abduction contracture of their shoulders for about 3 to 6 months after the operations. The cause of their osteoarthritic changes might be a postoperative abduction contracture.
A characteristic bone change like Hill-Sachs lesion (HS) and Osseous Bankart lesion (OB) are found in patients, such as whose with traumatic anterior shoulder instability. To detect these lesions, CT-arthrography (CTA) is most reliable. As a simple Xp-examination, we performed a Stryker notch view (SN) and 45craniocaudal view (45cc). The purpose of this study is to define the diagnostic value of SN and 45cc to HS and OB, compared with CTA.143patients who complained of apprehension or pain of the shoulder were examined. We performed a SN,45cc and CTA bilaterally on all the patiets. Sensitivity of the SN to HS was 70%, that of 45cc was 80%. But when using both views, the sensitivity increased to 93%. while using a CTA, the OB was classified into two groups. In the large group, the bone defect extended to the articular surface, and in the small group, the bone defect did not. Though the sensitivity of 45cc in both groups was 76%, that in only the large group was 93%. To detect HS, while using both views, we could obtain the same high sensitisity as with a CTA. For detecting OB,45cc was superior as a screening examination in only the large group, but difficult in the small group.
In this study, we evaluated the probe compression test (PC test) as a diagnostic mean for lesions of the rotator cuff. Thirtynine shoulder joints in 37 patients were evaluated. They were precisely diagnosed by arthrography, arthroscopy and intraoperative observation after the ultrasonic examination. Complete cuff tears were detected in 25 joints. Incomplete cuff tears were present in 7 joints.3joints showed the degenerative changes in the cuff. Ultrasonic examination was conducted by Aloka SSD 680 or 650 and a 7.5 MHz linear probe. PC test which means the compression to the cuff lesions with the probe were performed in the ultrasonic evaluation. If the patient felt some localized tenderness, PC test was considered positive. In the case of complete cuff tear,22/25 joints were positive in PC test and showed tenderness at abnormal ultrasonic points. In the case of incomplete cuff tear, the bursal side tear were more sensitive than articular side tear in PC test. We know that there is a certain correlation between tenderness and cuff lesion like cuff tear. We used an ultrasonic probe to diagnose cuff lesions. The results suggested that PC test serves as a complementary test to the ultrasonic evaluation for cuff lesions.
Objective, materials and methods; Fifty-four cases among sixty-two surgeries for a massive tear of the rotator cuff, which have been done since 1976, were reviewed in this paper. Massive tears were classified into three types, i. e., massive tear in which the tendinous portion of the rotator cuff remained more than 2cm (type 1), less than 2cm but more than 1cm (type 2) and less than 1cm (type 3), postoperative follow-up period ranged from one year to ten years and ten months, and the results were evaluated using the JOA scoring system. Results; In the cases of type 1 (n=13), ten cases were evaluated as excellent (90 points or more), and three cases as good (80-90 points). In type 2 cases (n=23), where Debeyre's procedure had been applied in all cases, the results were divided into 11 excellent,8 good,1 fair (70-79 points) and 3 poor (less than 69 points). In the cases of type 3 (n=18), a trapezius muscle transfer was performed on 12 cases, of which there were 2excellent,5 good,4 fair and 1 poor result. Multiple advancement procedure was performed on the rest of the 6 cases, where the tendons of the infrasupinatus and terres minor muscles advanced anteriorly, the sbuscapuularis tendon advanced posteriorly and the remaining defect was finally covered by the suprasupinatus tendon with a muscle advancement (Debeyre's procedure). In this group, all the results were evaluated as excellent or good. Discussion and conclusion; From the results of this study, there were few problems in the cases of type 1 and 2, however, in type 3, the results were not as good as those in the other groups. A multiple advancement technique provided better results than did a trapezius transfer in type 3.