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Jens O. Søjbjerg
1996 年 20 巻 1 号 p.
1-4
発行日: 1996/10/15
公開日: 2012/11/20
ジャーナル
フリー
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-筋電図学的研究-
桜井 悟良, 冨田 恭治, 仲川 喜之, 中垣 公男, 尾崎 二郎
1996 年 20 巻 1 号 p.
5-8
発行日: 1996/10/15
公開日: 2012/11/20
ジャーナル
フリー
The purpose of this study was to determine the function of the long head of biceps brachii in a rotator cuff injury.
(Materials and Methods) Ten men (10 shoulders) with intact cuff and ten men (10 shoulders) with rotator cuff tears (10 shoulders) were studied whose aveage ages were 51.7 years and 56.6 years, respectively. Electromyographic signals were recorded from the LHB with surface electrodes. The subject wore an elbow brace locked in the neutral forearm rotation and 0 degree of flexion to minimize the elbow-related biceps activity. EMG signals were collected at six arm positions and MVC. The positions were abduction in the scapular plane (90 and 150 degrees) in external or internal rotation (30 degrees) and 90 degrees flexion in external or internal rotation (30 degrees). The root mean square (RMS) value was used as a single estimate of the myoelectric power spectrum.
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-腱板断裂肩,非断裂肩の比較-
村井 肇, 井樋 栄二, 佐藤 毅, 皆川 洋至, 今野 則和, 佐藤 光三
1996 年 20 巻 1 号 p.
9-12
発行日: 1996/10/15
公開日: 2012/11/20
ジャーナル
フリー
The purpose of this study was to determine the muscle activity of the biceps during elevation of the arm. Eighteen shoulders were examined using dynamic EMG: nine shoulders with rotator cuff tears and nine without tears (normal controls). The muscle activity from the biceps was recorded at 30 °,60 °,90° and 120°of arm elevation in the scapular plane, with and without a 1-kg weight. EMG Activities were expressed as the percentage to the maximum voluntary contraction (% MVC). In four out of the nine shoulders with rotator cuff tears, the activity from the biceps was higher (high activity group) than that in the normal shoulders. The activity increased with the application of weight and with the increase of the elevation angle. However, the rest of the five shoulders with rotator cuff tears showed lower activity (low activity group) similar to the normal shoulders. MMT of the shoulder abductors in the low activity group tended to be higher in comparison with the high activity group. It seems that the biceps activity increases to assist abductors or to stabilize shoulders with rotator cuff tears.
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後藤 英之, 中野 幸雄, 高田 直也, 松井 宣夫, 平林 義章, 山田 和順, 杉本 勝正, 奥田 敏治, 大藪 直子
1996 年 20 巻 1 号 p.
13-19
発行日: 1996/10/15
公開日: 2012/11/20
ジャーナル
フリー
Purpose There have been few studies on the histochemical detection of glycosaminoglycans (GAGs) in the glenoid labrum. We observed the localization of GAGs in the glenoid labrum by means of sensitized diamine procedures.
Materials and Methods
Specimens were obtained from 21 joints,13 cases at autopsy. The mean age of the specimens was 75.9years with a range from 65 to 98. After macroscopic observation, the glenoid with a labrum was fixed 10%formaldehyde and decalcified. The glenoid was divided into 6 pie-slices by radial incision and then paraffin sections were made. The sections were stained with hematoxyline eosin and sensitized diamine procedures combined with selective methods (GAG-degrading enzyme digestion).
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佐野 博高, 熊谷 純, 沢井 高志
1996 年 20 巻 1 号 p.
21-25
発行日: 1996/10/15
公開日: 2012/11/20
ジャーナル
フリー
Purpose: There have been few reports on the repair process of the bony insertion after fascial patch procedure. The purpose of this paper is to descride the chronological histological changes of the grafted fasciabone junctions.
Materials and Methods: Defects were made at the supraspinatus insertion to the greater tuberosity in 22white rabbits. They were patched with autografts from the fasciae latae. The grafts and bones were removed at 4 days,1,2,3,4 and 8 weeks after the operations. Sections parallel to the orientation of the supraspinatus were decalcified at 4°C, embedded in paraffin and stained with hematoxylin-eosin, elastica-Masson and toluidine blue.
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城戸 正喜, 松崎 昭夫, 中村 宏, 入江 豊, 加藤 清信, 古賀 崇正
1996 年 20 巻 1 号 p.
27-29
発行日: 1996/10/15
公開日: 2012/11/20
ジャーナル
フリー
A deltoid splitting in-cision has recently been introduced as treatment for open rotator cuff surgery, open subacromial decompres sion surgery and shoulder arthroscopic surgery. This study was undertaken to determine at what distance the deltoid muscle can be split from the acromion with out risk of iatrogenic in-jury to the axillar nerve.
Twenty-five embalmed adult cadavic specimens (46 shoulders,18 male and 7 female cadavers) were dissected. The distance from the anterolateral corner and the poeterolateral coener fo the acromion to the main trunk of the axillary nerve on the under-surface of the deltoid muscle were measured using a ruler.
The average distance from the anterolateral corner of the acromion to the axillary nerve was 5.29cm and the average distance from the posterolateral corner to the axillary nerve was 5.01cm.
The shortest distance from the acromion to the axillary nerve was 4.1cm in males and 4.3cm in females in this cadaveric study. The deltoid splittimg approach should be limited to less than 4.0cm from the acromion to avoid in-jury to the axillary nerve.
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日野 高睦, 信原 克哉, 橋本 淳, 建道 寿教, 照屋 均
1996 年 20 巻 1 号 p.
31-35
発行日: 1996/10/15
公開日: 2012/11/20
ジャーナル
フリー
(Purpose) This study investigated the relationship between the arthrographical appearance of the rotator interval (RI) and the instability of the shoulder.
(Materials and Methods)
In 182 cases (116 Rl lesions,66 others) under 40 years old
(average 21.3), whose shoulders may have little degenerative change, the size of the Rl beyond the line between the lateral border of the horizontal portion of the coracoid and the anatomical humeral neck at the zero position on X ray films were measured and compared with the range of motion (ROM), loosening and slipping.
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冨田 恭治, 桜井 悟良, 大城 治, 尾崎 二郎
1996 年 20 巻 1 号 p.
37-39
発行日: 1996/10/15
公開日: 2012/11/20
ジャーナル
フリー
Owing to a superior soft tissue contrast, magnetic resonance imaging (MRI) is particularly valuable for the assessment of the synovium, cartilage, muscles, tendons, and ligaments. This study was undertaken to determine which kinds of informetion MRI can provide about a rtheumatoid shoulder.
Twenty-one patients with classical or definite RA who had visited our institutions and had shoulder complaints were included in this study. The mean age of the patients was 55 years (range 21-71). Several images in the transverse and oblique planes that is, perpendicular to the glenoid surface, were obtained. Then a series of patients with classical RA or definite RA had their sholders evaluated clinically and functionally.
MR imaging showed joint effusion or inflammatory synovial tissue in the glenohumeral joint or subacromial bursa, or both, in all patients. Nine of thirth-eight (23.7%) were interpreted as having tears. In a small lesion within the humeral head, MR imaging has demonstrated a greater sensitivity than othr imaging modalities. The focus of a varied signal intensity within the humeral head was detected in 23 shoulders (60.5%). Pannus or cyst formations appeared in an area of low signal intensity on a T1 weighted image.
MRI of the shoulder can provide significant information about osseous and soft tissue involvement of the glenohumeral joint and the subacromial space in patients with RA.
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-Dewar変法と比較して-
高瀬 勝己, 勝田 真史, 有沢 治, 永井 秀三, 今給黎 篤弘, 三浦 幸雄
1996 年 20 巻 1 号 p.
41-45
発行日: 1996/10/15
公開日: 2012/11/20
ジャーナル
フリー
Our unit conducted modified Dewar's procedure for type 3(Tossy's classification)acromioclavicular joint dislocation until 1993, when we switched to a modified Cadenat's procedure in order to obtain an earlier recovery from surgical invasion and an earlier increase in joint-motion range after surgery.
Twenty-four patients,20 males and 4 females, underwent this procedure. The therapeutic results were evaluated using Kawabe et al's evaluation criteria.
The joint-motion range returned almost to normal in 18 of the 24 patients by 3 months after surgery and to normal in all but 1 patient (an old case) by 1 year after surgery. The therapeutic results were “excellent”in 17 patients, “good” in 4, “fair” in 2 and “poor” in 1. X-ray findings showed a residual subluxation of several mm in 8 patients only.
Modified Cadenat's procedure seemed to be useful and to satisfy patients greatly, because it required less surgical invasion and enables them to obtain normal shoulder motion range more quickly than a modified Dewar's method, thus making prompt rehabilitation easier.
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吉田 篤, 小川 清久, 宇井 通雅
1996 年 20 巻 1 号 p.
47-51
発行日: 1996/10/15
公開日: 2012/11/20
ジャーナル
フリー
Twenty-three patients(23 shoulders)with distal clavicle resections were analyzed to clarify the usefulness of distal clavicle resection performed for acromioclavicular(AC)joint disease. The patients were 19 men and 4 women with an average age of 38 years, and ten of them had osteoarthritis or osteolysis(following an atraumatic onset, grade I AC joint sprain or intra-articular fracture of the AC joint),8 had an old grade II AC separation and 5 had an old grade III AC separation. Of the 13 patients with old AC separations, nine patients with hypermobility of the clavivle had concurrent coracoclavicular (CC) stabilization and one of the two patients with subacromial impingement had a concurrent anterior acromioplasty, in addition to a distal clavicle resection. At an average follow-up period of 18 months, all of the patients had no AC pain. However, three patients with an old AC separation had prominence of the distal clavicle or symptoms due to a residual hypermobility of the clavicle in spite of the CC stabilization, and the patient who had no anterior acromioplasty in spite of a subacromial impingement had unchanged impingement symptoms. The distal clavicle resection was useful to contact the pain between the distal clavicle and acromion, scapula spine or surrounding tissue caused by the deformity of the distal clavicle, incongruiy of the AC joint or hypermobility of the clavicle, but a CC stabilization is needed for the relief of the prominence of the distal clavicle and symptoms due to hypermobility of the clavicle in cases with hypermobility of the clavicle, and an anterior acromioplasty is needed in cases with subacromial impingement.
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原田 真一, 伊藤 信之, 衛藤 正雄, 朝長 匡, 鳥越 雄史, 岩崎 勝郎
1996 年 20 巻 1 号 p.
53-56
発行日: 1996/10/15
公開日: 2012/11/20
ジャーナル
フリー
Most of the scapula fracture are usually treated conservatively, however, in some cases complications like malunion, suprascapular nerve palsy and snapping scapula occur. We carried out plate fixation for the displaced glenoid fracture, unstable neck fracture and displaced body fracture along with clavicular fracture. We investigated the factors that affected the results of these operated cases.
The age of 8 patients(6 males,2 females)with scapular fracture from 22 years to 61 years with a mean age of 48 yeaes. The mean follow-up period was 30 months. Considering the type of the fracture,2 cases had displaced glenoid fractures, one cases had displaced body fracture along with clavicular fracture and the rest 5 cases had unstable neck fractures.
We evaluated the result b y using JOA score. We investigated the influence of the fracture type, the preoperative complications, period from the trauma to the beginning of elevation exercise and the JOA score. The average postoperative JOA score was 92.3 ± 10.2. The score of the patients with glenoid fractur e was 77.5 ± 10.6 and that of the other fractures was 97.3 ± 2.4 and this difference between two groups was mainly due pain score. The score of the cases with complications was 90.2 ± 11.1 and that of without complications was 99 but there was no signiticant difference between two groups. There was a negative correlation between the period from the trauma to the beginning of elevation exercise and JOA score. The correlation coefficient was -0.68.
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高橋 正明, 小川 清久, 宇井 通雅, 浪花 豊寿
1996 年 20 巻 1 号 p.
57-61
発行日: 1996/10/15
公開日: 2012/11/20
ジャーナル
フリー
The purpose of this study is to examine the appropriae methods of treatment for old fractures of the cocacoid.
10 cases with coracoidvractures untreated for more than 4 weeks after injury were analyzed.
The period between trauma and first examination ranged from 4 weeks to 6 months. They consisted of 7 men and 3 women. The age ranged 17 to 56 years. The affected sides were 4 cases on the right and 6 cases on the left. The 10 cases were classified according to Ogawa's classification as type I in one case, type II in 1, type III in 7 and type IV in 1.
Conservative treatments were done in type I, II and 3 of the 7cases of type III. Surgery was performed to reconstruct the scapuloclavicular connection in 4 cases of type III and type IV because they complained of pain due to an acromioclavicular dislocation or clavicular fracture of the lateral end. ALL the cases had excellent results.
In type I and type II, conservative treatments should be chosen, because patients have no trouble in their daily routines, even if the coracoid fractures fail to heal. In some cases of type III and type IV, surgery is required to acquire stability of the scapuloclavicular connection and relief of pain.
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(発症機序の検討)
小林 昌明, 村上 元庸, 吉川 玄逸
1996 年 20 巻 1 号 p.
63-66
発行日: 1996/10/15
公開日: 2012/11/20
ジャーナル
フリー
[Purpose]
Expiphyseal separation of the coracoid process is rare. We studied the mechanism of this injury.
[Materials]
We experienced 5 cases(6 shoulders) of this injury. The patients were all junior high school students, and belonged to a sport's club. The causes of all the injuries were contusion of the shoulder girdle.
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浜田 純一郎, 玉井 和哉
1996 年 20 巻 1 号 p.
67-70
発行日: 1996/10/15
公開日: 2012/11/20
ジャーナル
フリー
Neer's classification of proximal humeral fractures is widely accepted. However, fractures are encountered that are inconsistent with this system of classification. The objective of this study was to characterize such fractures, in which the fracture anatomy was observed during surgery.
Twenty shoulders of 19 patiants with displaced proximal humeral fractures or fracture-dislocations were studied. The subjects consisted of 7 males and 12 females; the age ranged from 17 to 85 years, an averaged was 64 years. The operative examination revealed: a 3-part fracture in 5 shoulders, a 4-part fracture in 4, a 3-part fracture-dislocation in 6 and 4-part fracture-dislocation in 5.
The operative findings of each case were compared with the preoperative roentgenograms and with Neer's classfication.
Five shoulders with a 3-part fracture were fractured in the greater tuberosity. Two displaced head patterns were found: 1)a valgus displacement in 3 cases,2)an internal rotation in 2 cases. Two causes of valgus dis placement were figured out. The first was the lesser tuberosity left to the shaft side, and the second was a head attached to the lesser tuberosity impacted to the shaft. Of the 4-part fractured shoulders, all the heads displaced into the valgus appear in Neer's classification. Five of the 3-part fracture-dislocation shoulders showed a fracture pattern which is not in Neer's classfication. In these cases, the greater and lesser tuberosi ties were not divided the one from the other but rather composed as a‘part’ which was displaced from the humeral head and from the shaft.
When we observe a proximal fracture, the fracture type should be determined by the head displacement pat tern rather than by the number of parts.
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仲川 喜之, 尾崎 二郎, 梅垣 修三
1996 年 20 巻 1 号 p.
71-76
発行日: 1996/10/15
公開日: 2012/11/20
ジャーナル
フリー
We have performed open reduction and internal fixation by Rush pin and wire on 20 cases of the fractures of the proximal humerus. The purpose of this study is to introduce our method and to evaluate the postoperative results.
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-%MMTとの比較を中心に-
鈴木 一秀, 山本 龍二, 三原 研一, 保刈 成, 上里 元, 大島 和, 内川 友義, 菅 直樹, 牧内 大輔, 筒井 廣明, 山口 光 ...
1996 年 20 巻 1 号 p.
77-80
発行日: 1996/10/15
公開日: 2012/11/20
ジャーナル
フリー
tegrated electromyography and the %MMT.
(Materials and Methods) Fourteen sholders of seven young males(group I )and fourteen shoulders of seven young males (group II), who had no symptoms on the shoulders, were studied. The activity of the supraspinatus, infraspinatus, deltoid, and biceps were evaluated electromyographically with the load at 45 degrees elevater position in the scapular plane. Further, each EMG activity was integrated. Subsequently, the maximum integrated EMG acticity during MMT(Max MMT) was defined as a normal vaue (100%) and each activity was expressed as a percentage of the Max MMT(%MMT)with group II.
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三森 甲宇, 野本 栄, 中川 照彦, 古屋 光太郎, 石田 明允
1996 年 20 巻 1 号 p.
81-85
発行日: 1996/10/15
公開日: 2012/11/20
ジャーナル
フリー
Purpose
Recently, we know the great importance on the glenohumeral ligaments have stability of the shoulder joint. In this report, the tensile strength of the anterior capsule was evaluated in external rotation of the glenohumeral joint.
Methods
Eight glenohumeral joints of cadavers were used. The rotator cuff was cut at the site of the insertion and the long head of the biceps tendon was cut at the musculotendinous junction. The capsule and coracohumeral ligament were retained. The scapula was fixed on a plate, and the humerus was rotated externally by investigator in various positions. The tensile strength of the anterior capsule was measured, using three buckle transducers. Then we cut open the capsule along the inferior edge of the coracohumeral ligament (nearly the rotator interval). Then the tensile strength was evaluated by the same techniques as afore-mentioned.
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井口 理, B. S. Olsen, M. T. Vaesel, H. V. Johannsen, J. O. Søjbjer ...
1996 年 20 巻 1 号 p.
87-90
発行日: 1996/10/15
公開日: 2012/11/20
ジャーナル
フリー
The intraarticular pressures of the glenohumeral joint were measured in 15 cadaveric shoulders during passive movement of the humerus and under various inferior loads on the humerus. Using the fiber-optic transducertipped catheter and air-tight connector, the basic intraarticular pressure was measured directly without the injection of any physiological saline solution the joint prior to the measurement. The initial intraarticular pressures were all negative with a mean value of -67.8 mmHg. During abduction-adduction movement the minimal intraarticular pressure was measured at 20 degrees of humeral abduction. During rotation, the minimal intraarticular pressure was observed at neutral humeral rotation. The intraarticular pressure decreased nearly linearly with the increasing inferior load on the humerus. These results indicate that the intraarticular pressure takes part in the stabilization of the glenohumeral joint and the negative intraarticular pressure of the glenohumeral joint induces the maximal stabilizing effect at 20 degrees of humeral abduction and neutral humeral rotation.
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田中 直史, 大沢 正秀, 夫 猛, 大槻 伸吾, 大久保 衞
1996 年 20 巻 1 号 p.
91-96
発行日: 1996/10/15
公開日: 2012/11/20
ジャーナル
フリー
PURPOSE
We have reported that there are scapulo-humeral rhythms in the horizontal planes with flexion and extention of the shoulder joint as well as with the elevation of arms and decrease in movements of scapulo-thoracic joint by ageing. Now we wish to propose that there also exists a scapulo-humeral rhythm in the rotation of the shoulder.
SU BJECTS AND METHODS
We measured the scapular inclination in seven normal volunteers ranged from 23 to 37(mean: 31), using an X-CT and setting it at a neutral position with the shouldes in abduction 0 ° and flexion 0° and the elbow in flexion 90 ° . The scapular inclinations were measured:
1)from neutral to 30° and the maximal rotatio nal position (internal and external)
2)at neutral and 30 ° rotation (internal and external) when maximal rota tion isotonic motion were performed.
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白浜 克彦, 伊藤 信之, 衛藤 正雄, 朝長 匡, 原田 真一, 岩崎 勝郎
1996 年 20 巻 1 号 p.
97-101
発行日: 1996/10/15
公開日: 2012/11/20
ジャーナル
フリー
Purpose
The movement of the shoulder complex has been described as the scapulo-humeral rhythm by Codman. It has been stated that the scapula moves with the humerus in a 1: 2 ratio in this rhythmic procese.
Changes of the tilting angle of the scapula were continuously evaluated radiographically with an image intensifier in three dimensions during arm elevation and deperssion to analyze this rhythm.
Materials
10 normal shoulders were examined for this study.
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-筋外腱移行形態について-
皆川 洋至, 井樋 栄二, 佐藤 毅, 今野 則和, 本郷 道生, 佐藤 光三
1996 年 20 巻 1 号 p.
103-109
発行日: 1996/10/15
公開日: 2012/11/20
ジャーナル
フリー
Each muscle of the rotator cuff is known to have several intramuscular tendons which provide attachment to numerous muscle fiders. The anatomical relationship between intramuscular and extramuscular tendons needs to be determined to know the distribution of the force to the rotator cuff tendon. The purpose of this study was to clarify the morphology of the transitional zone of intramuscular to extramuscular tendons of the rotator cuff.
The muscle fibers of cuff muscles of 20 embalmed shoulders without full-thickness rotator cuff tears were removed to examine the transitional zone of the intramuscular to extramuscular tendons macroscopically. Histological sections of the musculotendinous junction were perpared to evaluate the transitional forms microscopically.
We defined the intramuscular tendon as the tendon inside the muscle belly and the extramuscular tendon as the tendon outside the muscle. The extramuscular tendons from the rotator cuff tendon distally. Location was expressed as the % position of the anterior and posterior margins of the musculotendinous junction. The intramuscular tendons of the infraspinatus, teres minor, and subscapularis were contiguous to the whole extramuscular tendons and that the supraspinatus was located in the anterior one-third of the extramuscular tendon(0±0% to 28±15%). Microscopically, the intramuscular tendon of the supraspinatus formed a tendon fiber bundle and was continuous with the second of five layers of the extramuscular tendon (Clark and Harryman,1992).
Conclusion: The connection of intramuscular tendon to extramuscular tendon was specific to each cuff muscle. The intramuscular tendon of the supraspinatus was attached to the anterior one-third of the extramuscular tendon and was contiguous to the second layer.
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中野 幸雄, 高田 直也, 後藤 英之, 松井 宣夫, 藤森 修, 山田 和順, 杉本 勝正, 大薮 直子
1996 年 20 巻 1 号 p.
111-116
発行日: 1996/10/15
公開日: 2012/11/20
ジャーナル
フリー
Purpose
The anatomical characteristics and nerve distribution in the coracohumeral ligament(C-Hligament)and surrounding tissue were studied. The role of the ligament in periarthritis of the shoulder was assessed.
Materials and Methods Specimens were obtained from 30 cases,50 joints at autopsy. The cases consisted of 14 males and 16females; with an age range from 29 to 98 years(mean 78 years). The C-H ligament and its surrounding tissues were excised en bloc.
Paraffin sections, vibratome sections and whole mount preparations were made and subjected to immunohistochemical staining using NF, PGP9.5, SP and CGRP antibodies in order to the distribution of sensory nerve fibers.
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-形態および分布について-
森澤 豊, 川上 照彦, 山本 博司, 貞広 哲郎
1996 年 20 巻 1 号 p.
117-121
発行日: 1996/10/15
公開日: 2012/11/20
ジャーナル
フリー
The pathogenesis of a rotator cuff lesion of the shoulder is still controversial.
The authors investigated the mechanoreceptors in the rotator cuff, the subacromial bursa and the coracoacromial ligament in order to clarify the proprioception of the shoulderjoint.
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小野 秀文, 脇谷 滋之, 桑田 賢二, 井本 一彦, 村田 紀和, 米田 稔
1996 年 20 巻 1 号 p.
123-125
発行日: 1996/10/15
公開日: 2012/11/20
ジャーナル
フリー
We have reported that the pattern of shoulder joint destruction in RA was classified into 5 group: Non-progressive (N type), Osteoarthritis-like (OA type), Erosive (E type), Collapse (C type), and Mutilating (M type). The natural courses of progressions and prognoses for each of those 5 types are different. We studied the relationships between the patterns of shoulder joint destruction in RA and the HLA-DRB1 gene frequencies. Numbers of joints in each of N, OA, E, C and M type were 127,15,38,6,18, respectively; phenotypic frequency of HLA-DRB1 0405 were 53.5%,80.0%,63.2%,33.3%,100%(mean: 59.3%), respectively. M type showed a significant correlation with HLA-DRB1 O405. RA is known to associate with HLA-DRB1 0405 in Japan. This study demonstrated that the pattern of shoulder joint destmction in RA was associated with the HLA-DRB1 0405 gene.
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上里 元, 山本 龍二, 三原 研一, 保刈 成, 鈴木 一秀, 大島 和, 内川 友義, 菅 直樹, 牧内 大輔, 筒井 廣明, 山口 光 ...
1996 年 20 巻 1 号 p.
127-130
発行日: 1996/10/15
公開日: 2012/11/20
ジャーナル
フリー
The function of the rotatou cuff is a dynamic stabilizer of the gelnohumeral joint. Clinically, we assessed this function by a “Scapula-45” radiographic examination. The aim of thie report is to assess the function of the rotator cuff chronologically.
Ten normal shoulders of ten cases rarging from their teens fifties were studied here. They were assessed by Scapula-45 and the cuff indices which were associated with the function of the rotator cuff were compared with the nomal index.
In a normal case, the cuff index at 45 degrees of abduction on the scapula plane with a 3kg load was -1.5±1.5, centralizing the humeral head within the glenoid fossa. In this study,10% of the teens and those in their twenties revealed a high cuff index,30% in their thirties,40% in their forties, and 70% in their fifties. These results suggest that the function of the rotator cuff is affected with aging.
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今野 則和, 井樋 栄二, 佐藤 毅, 皆川 洋至, 小林 孝, 佐藤 光三
1996 年 20 巻 1 号 p.
131-134
発行日: 1996/10/15
公開日: 2012/11/20
ジャーナル
フリー
Introduction
The purpose of this study was to compare the incidence location and size of the glenoid osteophyte using plain radiographs between patients with and without rotator cuff tear.
Materials and methods
Of the 70 shoulders of 70 patients with symptomatic shoulders examined by arthrography.41 shoulders had rotator cuff tears with an average age of 63 years, and the rest of the 29 shoulders were wethout tears with an average age of 57 years. Using A-P X rays in 1) arm hanging position and 2) arm elevated position, the incidence location and size of the glenoid osteophytes were recorded.
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小倉 丘, 吉川 豪, 浅原 弘嗣, 前原 孝
1996 年 20 巻 1 号 p.
135-138
発行日: 1996/10/15
公開日: 2012/11/20
ジャーナル
フリー
Purpose
Although a ruptured rotator cuff is usually repaired using McLaughlin's method, the technique is somewhat complex because the tendon should be sutured to bone. We explored a method using a suture anchor system to reduce technical problems.
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小山 茂和, 土居 宗算, 小野村 敏信
1996 年 20 巻 1 号 p.
139-143
発行日: 1996/10/15
公開日: 2012/11/20
ジャーナル
フリー
In an attempt to quantitate the scapulohumeral rhythm of periarthritis sacpulohumeralis, we measured the angle of abducuion when the peak of the greater tuberosity has reached the lateral edge of the acromion under dynamic ultrasonography.
We perfomed dynamic ultrasonoraphy on the nineteen patients who had a painful stiff shoulder. There were eleven males and eight females with an average age of 58.6(44-70)years. Cases such as disorder of the rotator cuff and long head of the biceps, were excluded from this series.
The probe was placed on the peak of the greater tuberosity and lateral edge of the acromion in the long axis view of the supraspinatus tendon. Then the shoulder joint was abducted actively in the plane of the scapula keeping the thumb up. When the greater tuberosity had reached under the lateral edge of the acromion in the image of ulrasonography, the angle between the trunk and upper extremities was measured(named I angle) using the image of a video recoder which had recorded from the back simultaneously.
The mean of I angle was 40.9 degrees in a normel shoulder. Seven patients who had contracture of the shoulder joint complained of pain at the time the peak of the greater tuberosity had reached under the lateral edge of the acromion. In these cases, the I angle in the affected side is more than that in the contralateral side.
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-観血的治療例の検討-
井手 淳二, 山鹿 眞紀夫, 北村 歳男, 大橋 浩太郎, 田上 学, 平井 康裕, 高木 克公, 森澤 佳三
1996 年 20 巻 1 号 p.
145-150
発行日: 1996/10/15
公開日: 2012/11/20
ジャーナル
フリー
(Purpose)
We wish to present our study on the surgical management of the axillary nerve and suprascapular nerve lesions.
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土金 彰, 中土 幸男, 斉藤 覚, 松田 智, 畑 幸彦, 松江 練造, 杉本 良洋, 下川 寛一
1996 年 20 巻 1 号 p.
151-155
発行日: 1996/10/15
公開日: 2012/11/20
ジャーナル
フリー
Entrapment neuropathy of the shoulder caused by ganglia is rarer than that of the elbow and ankle. We wish to report on four cases with entrapment of the suprascapular nerve by a ganglion.
Clinical materials
All the patients were males with their ages ranging from 23 to 41 years old. They complained of shoulder pain, especially nocturnal pain. Physical examination revealed remarkable muscle atrophy of the infraspinatus and tenderness on the muscle. The preoperative range of motion of the shoulder was almost normal but a weakness of external rotation was present. Ultrasonography revealed a low echogenic shadow and MRI in T2-weighted image showed a high intensity. We could recognize the existence of a ganglion preoperatively. EMG studies demonstrated a partial denervation of the infraspinatus muscle and the terminal latency time of the muscle was delayed. Operations were performed in all cases. We exposed the suprascapular nerve after dissecting the posterior deltoid. A ganglion was present in the spinoglenoid notch and compressed the nerve medially. The ganglion including the pedicle was excised.
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山田 光子, 鈴木 克侍, 中川 史, 山元 宏介
1996 年 20 巻 1 号 p.
157-160
発行日: 1996/10/15
公開日: 2012/11/20
ジャーナル
フリー
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大塚 稔
1996 年 20 巻 1 号 p.
161-164
発行日: 1996/10/15
公開日: 2012/11/20
ジャーナル
フリー
Purpose: The purpose of this study is to report the usefulness of combining an interscalene block with a laryngeal mask anesthesia.
Materials and Methods: Thirty one cases were examined in this study. The case were as follows; 7 clavicle fractures,4 ACJ dislocations,3 recurrent shoulder dislocations,6 rotator cuff tears,2 contractures of the shoulder and 6 humeral fractures,3 benign tumors of the upper arm. After performing the interscalene block, the patient was seated in the beach chair position or lateral position. After confirming the patient was in no have harm in this position, we put on the larygeal mask. Then we began to operate.
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-腱付着部における化学的因子の検討-
後藤 昌史, 浜田 一寿, 朝長 昭仁, 福田 宏明
1996 年 20 巻 1 号 p.
165-170
発行日: 1996/10/15
公開日: 2012/11/20
ジャーナル
フリー
Purpose
The purpose of this study was to detect possible chemical factors which contribute to bone and cartilage destruction in the insertion in rotator cuff tears by immunohistochemical technique.
Materials and Methods
Six cases of complete cuff tears and eleven cases of incomplete cuff tears were examined. The torn portion of the supraspinatus tendons including greater tuberosity was harvested during operations. These were embedded in paraffin following 10% neutral buffered formalin fixation for 48 hours and demineralization. The possible chemical mediators, i. e interleukinl β, cathepsin D and matrix metalloproteasel were stained using indi rect immunoperoxydase technique. Hematoxylin and eosin staining was also performed.
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-組織所見と膠原細線維の定量的分析-
中川 照彦, 伊藤 聰一郎, 内田 欣也, 三森 甲宇, 田中 誠, 冨岡 秀樹, 石突 正文, 古屋 光太郎
1996 年 20 巻 1 号 p.
171-176
発行日: 1996/10/15
公開日: 2012/11/20
ジャーナル
フリー
[Purpose]The purpose of this paper is to examine the presence of an intrinsic healing in the torn sites of the rotator cuff and to evaluate the quantitative analysis of the collagen fibrils.
[Materials and Methods] Specimens of rotator cuffs were obtained from nine patients aged 51 to 69 who underwent surgery. The biopsies from four sites (non-torn site, distal stump, superficial and deep layers of the proximal stump) were performed.
1) Ultrastructual observation of the fibroblasts was performed by electron microscope.
2) The quantitative analysis of the collagen fibrils was performed using a personal computer.
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遠藤 健次, 福島 孝
1996 年 20 巻 1 号 p.
177-180
発行日: 1996/10/15
公開日: 2012/11/20
ジャーナル
フリー
In the motion of the shoulder, an abduction coexists with the scapular external rotation. If the humeral rotaiton is kept in the same degree during a shoulder abduction, the acromion leaves from the greater tuberosity of the humerus by means of the scapular external totation. The purpose of this study is to evaluate the relationship between the motion of a scapular external rotation and the appearance of a shoulder impingement. (materials) 32 patients showed a shoulder impinement (aged 41-81, average 58.3). They all had normal shoulder conditions on the other side.4cases of complete dislocation of the acromio-clavicular joint were also evaluated, so that the pathogenesis might be explained.
(Methods) We examined patients' shoulders bilaterally using a plain radiography (standing, APview)which consisted of two views. The 1st AP view was at O degrees of shoulder abduction with the upper arm in a neutral position. The 2nd AP view was at 45 degrees of shoulder abduction with the upper arm in a neutral position. In each radiograph the distance between the upper end of the coracoid process and the scapular spine was measured.
(Results) In the 45 degree shoulder abduction group, the painful sides showed a lower degree of scapular external rotaiton than the painless sides(p <0.05). In the acromio-clavicular dislocation group,3cases showed a lower degree of scapular external rotation in the affected side. Anatomically, the loss of scapular external rotation was thought to be due to the disfunction of the trapezius muscle. The loss of scapular external rotation correlates closely with a shoulder impingement.
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渋田 秀雄, 田渕 健一, 玉井 和哉
1996 年 20 巻 1 号 p.
181-184
発行日: 1996/10/15
公開日: 2012/11/20
ジャーナル
フリー
[Purpose] Magnetic resonance (MR) imaging of the shoulder is usually done With the patients lying in a cylindrical drical gantry with their arms at their sides. This position of the shoulder greatly differs from the one that could cause pain in subacromial impingement syndrome. The purpose of this study is to determine whether the MR Imaging of the abducted arm affords more information on the subacromial space as compared with that of the adducted arm.
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金崎 克也, 稗田 寛, 後藤 博史
1996 年 20 巻 1 号 p.
185-188
発行日: 1996/10/15
公開日: 2012/11/20
ジャーナル
フリー
Arthrography of the shoulder is useful for a complete cuff tear. But for an incomplete tear, it can not explain the condition of the internal tendon. Recently, MRI has become popular. So, we examined shoulder joints with a rotator cuff injury by MRI and compared them with our operative findings.
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藤田 健司, 岩崎 安伸, 三輪 雅彦, 水野 耕作, 高橋 信男
1996 年 20 巻 1 号 p.
189-192
発行日: 1996/10/15
公開日: 2012/11/20
ジャーナル
フリー
(Introduction) MRI(Magnetic resonance imaging) offers an alternative, noninvasive technique for investigating lesion of the rotator cuff.
Gd-DTPA enhanced MRI, on the other hand, has been used in many fields, especially to visualize tumors. The purpose of this study is to evaluate the images of full-thickness rotator cuff tear in Gd-DTPA enhanced MRI.
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末永 直樹, 三浪 明男, 加藤 博之, 近藤 真, 福田 公孝
1996 年 20 巻 1 号 p.
193-196
発行日: 1996/10/15
公開日: 2012/11/20
ジャーナル
フリー
In 1993, we reported that the site of a subacromial impingement was guessed by the pathological changes of the undersuface of the acromion. On the other hand, the undersurface of the acromion could be observed by using a bursoscopy.
Our purpose in this paper is to clarify the role of bursoscopy in order to determine the site of a subacromial impingement. Bursoscopical and pathological examinations of the acromions and coracoacromial ligaments were performed on twenty-five patients with subacromial impingement syndrome. The impingement sites were estimated from the pathological findings of the hypertrophic changes of the fibrous cartilage layer. The existence of pathological findings along the coracoacromial ligament fibers were impinged at the coracoacromial ligament (eight shoulders). Hypertrophic changes of fibrous-cartilage, not along the coracoacromial ligament suggested an impingement at the acromion (four shoulders). Both chages above mentioned in the acromion suggested an impingement at both sites (thirteen shoulders).
The bursoscopical findings at acromial undersurface were classified into four types: normal, buttered surface of the coracoacromial ligament, eburnation and impossible to observe. In the cases of impingement of the coracoacromial ligament obtained from the pathological findings, six casses were normal and the acromial undersurface could not be observed in two bursoscopically. In cases of impingement at the acromion, the bursoscopic findings showed buttered the surfade of coracoacromial ligament in ten shoulders, eburnation in six and impossible to observe in one. The findings of acromion undersurface bursoscopically suggests the site of the impingement in subacromial impingement syndrome.
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東 敦, 田辺 知宏, 原 勇, 玉井 和哉, 立石 昭夫
1996 年 20 巻 1 号 p.
197-200
発行日: 1996/10/15
公開日: 2012/11/20
ジャーナル
フリー
We experienced 2 cases of post-cuff repair arthropathy, which may have been caused by pyoctanine solution.
Case 1; A 40-year-old housewife developed pain in her right shoulder when playing volleyball in 1988. She was operated on with a diagnosis of bursal side tear of the rotater cuff in March 1990. At surgery, a full-thickness tear was denied by a color test with diluted pyoctanine solution. The postoperative course was uneventful, but, three years after surgey, she again developed shoulder pain and loss of joint space was found on x-ray, A hemiarthoplasty was made in February 1995, when eburnated humeral head and glenoid fossa was noted.
Case 2; A 56-year-old housewife fell on her right hand at skiing. She was operated on with a diagnosis of full-thickness cuff tear in July 1991. A color test with diluted pyoctanine solution was performed to visualise the intratendinous extension of the tearing. The postoperative couse was uneventful for three years. She had hemiarthroplasty in May 1995 for severe shoulder pain associated with loss of joint space. The intraope rative pathology was similar to that of Case 1.
Conclusion; Pyoctanine solution should not be used in color test.
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森澤 佳三, 浅見 昭彦, 伊藤 純, 西川 英夫, 渡辺 英夫, 竹下 満, 平田 修
1996 年 20 巻 1 号 p.
201-204
発行日: 1996/10/15
公開日: 2012/11/20
ジャーナル
フリー
Purpose
We sometimes find osteoarthritis of the glenohumeral joint in some cases with massive rotator cuff tears. In this report, We would like to discuss what is the best treatment for osteoarthritis of the glenohumeral joint associated with a massive rotator cuff tear.
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後藤 康夫, 村 成幸, 松田 雅彦, 寒河江 正明, 佐藤 哲也, 大島 義彦
1996 年 20 巻 1 号 p.
205-208
発行日: 1996/10/15
公開日: 2012/11/20
ジャーナル
フリー
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井樋 栄二, 皆川 洋至, 今野 則和, 小林 孝, 佐藤 毅, 佐藤 光三, 西登 美雄
1996 年 20 巻 1 号 p.
209-211
発行日: 1996/10/15
公開日: 2012/11/20
ジャーナル
フリー
This study was designed to investigate the smoking habits in patients with rotator cuff tears. We evaluated 104 patients with rotator cuff tears (average age,62 years). The number of cigarettes/day and years of smoking were recorded. Diagnosis of rotator cuff tear was established by arthrography, MRI, or during surgery. The tear size was determined on MRI or during surgery and categorized into 3 groups: small, medium, and large. Smoking rate of the patients was compared with that of the Japanese population. The overall smoking rate in patients with rotator cuff tears was 38%, which was similar to that of the population (36%). The smoking index (number of cigarettes/day x years of smoking) was significantly correlated with the tear size(r=0.374, p=0.0160); the higher the smoking index, the larger the tear size. This suggests that smok ing may be related to the development of rotator cuff tears.
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中垣 公男, 大城 治, 岡橋 達晃, 冨田 恭治, 桜井 悟良, 尾崎 二郎
1996 年 20 巻 1 号 p.
213-216
発行日: 1996/10/15
公開日: 2012/11/20
ジャーナル
フリー
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-MRIを用いて-
森石 丈二, 黒田 重史, 住吉 徹是, 斎藤 政憲, 丸田 喜美子, 菅谷 啓之, 石毛 徳之
1996 年 20 巻 1 号 p.
217-219
発行日: 1996/10/15
公開日: 2012/11/20
ジャーナル
フリー
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-骨棘および肩峰形成との関連-
末永 直樹, 三浪 明男, 加藤 博之, 福田 公孝
1996 年 20 巻 1 号 p.
221-224
発行日: 1996/10/15
公開日: 2012/11/20
ジャーナル
フリー
To clarify how much the anterolateral edge of the acromion can be removed by arthroscopic anterior acromioplasty, fifty acromions and coracoacromial ligaments were obtained en bloc from cadavers and patients with subacromial impingement syndrome treated by Neer's anterior acromioplasty. The specimens were sliced along the line of coracoacromial ligament fibers and stained with toluidine blue for microscopic observation. The amount of arthroscopically removable bone was determined by measuring the distance from the bursal side of the deltoid muscle to the bursal side of the bony later of the anterio lateral edge of the acromin. The anteroinferior acromial spur and acromial morphology taken from the supraspinatus view was observed. The correlation between the amount of arthroscopically removable bone and these findings was investigated. The amount of anterior lateral edges of the acromion that can be removed very small(ranging from 1 mm to 4.8mm; average 2.5mm), and is not related to an anterior acromial spur or acromil morphology.
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内田 欣也, 中川 照彦, 田中 誠, 富岡 秀樹, 土屋 正光, 久保田 耕造
1996 年 20 巻 1 号 p.
225-227
発行日: 1996/10/15
公開日: 2012/11/20
ジャーナル
フリー
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小竹 俊郎, Kiyoshi TAMURA, Yoshio KATAOKA, Taku MIHARA, Susumu UNENO
1996 年 20 巻 1 号 p.
229-231
発行日: 1996/10/15
公開日: 2012/11/20
ジャーナル
フリー
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-patch使用例とpatch非使用例の比較-
井阪 佳照, 米田 稔, 中川 滋人, 林田 賢治, 伊澤 一隆
1996 年 20 巻 1 号 p.
233-236
発行日: 1996/10/15
公開日: 2012/11/20
ジャーナル
フリー
(Purpose)
In rotator cuff repairs, we sutures the cuff to the bony trough on the greater tuberosity by the pullout technique (group M), and a Gore Tex patch was applied when a defect remained.
This study investigated the clinical outcome and compared the relati onship between the postoperative abduction strength and the patch size. (Materials) Sixty-nine shoulders underwent cuff repair and were followedup for over 1 year. There were 49 shoulders in group M. Twenty other shoulders operated with patches were classified in two groups, a small patch group (n=9) and a large patch group(n=11). A small patch was <2cm in diameter, and a large patch was >2cm. (Evaluation) the clinical outcome was evaluated using the JOA score, and the abduction strength at 90-degrees abduction, the relationship between the clinical outcome and the patch size analyzed. (Results) The JOA score improved from 73.1 to 92.2 points in group M, from 56.7 to 85.6 in the small patch group, and from 54.6 to 86.1 in the large patch group. The pain scores improved the most from 14.0 to 28.0,8.9 to 27.1, and 9.1 to 27.1 respectively. The JOA scores showed no significant difference among the groups. postoperative abduction strength was 5.2kg,6.0kg, and 1.6 kg respectively. There were no significant differences between group M and the small patch group, but there were between the large patch group and the other two groups. (Conclusion) Rotator cuff repair with a gore Tex patch improved the JOA score, with pain improving the most. The postoperative abduction strength in the small patch group was similar to that in group M.
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土居 宗算, 宮本 茂好, 小山 茂和, 成山 雅昭, 加納 敬庸, 福山 時仁, 福西 邦素, 小野村 敏信
1996 年 20 巻 1 号 p.
237-240
発行日: 1996/10/15
公開日: 2012/11/20
ジャーナル
フリー
[Purpose]
Various pathological processes cause painful shoulders of middle aged patients. This paper reports on the ultrasonographic changes in these shoulders.
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