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Jiro OZAKI
1996 Volume 20 Issue 2 Pages
261-264
Published: November 30, 1996
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Repetitive high-velocity throwing motion can result in chronic micro trauma to the stabilizing mechanism or the neurological system of the shoulder joint. Secondarily, injuries involving the rotator cuff, the subacromial bursa, the bicipital long head, the glenoid labrum and the axillary nerve may occur. The clinicians should clearly delineate in the concepts regarding the etiology of shoulder pain in overhead-throwing athletes. The evaluation, diagnosis and treatment of the throwing injuries of the shoulder require an understanding of the throwing mechanics and the shoulder joint motion. Here, diagnosis and treatment of the representative shoulder injuries are described based on their pathomechanism.
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Kai-Nan An
1996 Volume 20 Issue 2 Pages
265-271
Published: November 30, 1996
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Kenji HAYASHIDA, Minoru YONEDA
1996 Volume 20 Issue 2 Pages
273-276
Published: November 30, 1996
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The purpose of this study was to investigate whether the anterior and posterior shoulder laxity can be evaluated or not before operation using an anterior and posterior stress X-ray.
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Katsumasa SUGIMOTO, Huminori FUJIYOSHI, Shinji YOGO, Toshiharu OKUDA, ...
1996 Volume 20 Issue 2 Pages
277-280
Published: November 30, 1996
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Abstract
It is very important to evaluate the functions of the anteroinferior glenohumeral ligament-labrum complex(AIGHLC) before surgery of recurrent anterior shoulder instability in order to decide on the surgical technique. However, up to now the AIGHLC has been evaluated only from a morphological view point. In this study, we attempted to evaluate the functions of the AIGHLC by means of a CT-arthrography.
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Hidefumi HIROSE, Etsuo FUJIMAKI, Tomoo KATAGIRI, Takeshi OGAWA, Mikihi ...
1996 Volume 20 Issue 2 Pages
281-286
Published: November 30, 1996
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Purpose
We evaluated the arthroscopic Bankart's suture repair (Habermeyer technics) based on the MR arthrograms in this report.
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Intraoperative Findings and Methods of Repair in Recurrent Dislocation of the Shoulder
Tomohisa SATO, Fumio KATO, Hidekazu TOGA, Hiroki HARUYAMA, Satoshi KOI ...
1996 Volume 20 Issue 2 Pages
287-290
Published: November 30, 1996
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Recently, many arthroscopic studies have been reported trying to assess and repair a Bankart lesion. We performed open Bankart repairs combined with a Bristow procedure, and felt the need to reevaluate the methods of repair as related to our operative findings.
From 1984 to 1994,69 shoulders of 67 patients were treated using a Bankart-Bristow combined operation. Intraoperative findings were assessed from the operation records and classified according to Rowe's classification. The types of Bankart lesion were correlated with the methods of repair.
A Bankart lesion was found in all the patients. The findings were classified as follows: Type I,6 shoulders in 5 cases (8.7%), Type II '19 shoulders in 19 cases (27.5%), Type III,35 shoulders in 34 cases (50.7%), and, Type IV,9 shoulders in 9 cases (13.0%). In the cases of Type I, we sutured the lebrum together with the capsule to the glenoid edge. In Type II, and III, the labrum was repaired and the capsule was sutured to the glenoid edge. In Type IV, the bone fragment was either removed or fixed with screws.
A Bankart- Bristow combined procedure gave good results, but we need to refine the intraoperative observation by adding a preoperative arthroscopic examination.
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Jun KUMAGAI, Hirotaka SANO, Tomomaro KAWAMATA, Katsumi SATO, Koji ISHI ...
1996 Volume 20 Issue 2 Pages
291-297
Published: November 30, 1996
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To establish a reproducible classification of the intraarticular changes of traumatic recurrent anterior dislocations and subluxations, we arthoscopically observed 111 shoulders of 110 patients. The patients were 80 males and 30 females, aged from 12 to 50 years (mean 23), with 70 dislocations and 41 subluxations. They all had episodes of traumatic onset of symptoms and positive apprehension signs.
The pathology of anterior supporting mechanisms was classified into 4 types.
1) Ligament-Labrum complex (L-L complex) detachment type: labral soft tissue detached from the anteri glenoid rim (90 shoulders), a: detached at the antero-inferior region (85 shoulders), b: detachment extending to the origin of the long head of the biceps (5 shoulders).2) Small bony fragment type: L-L complex detached with small bony fragments which adhered to the antero-inferior suace of the glenoid rim (15 shoulders).3)Glenoid bony defect type: large bone defect at the glenoid (3 shoulders).4)Hypotonic type: absence of any obvious detachment with redundant glenohumeral ligament (3 shoulders).
In our arthroscopic Bankart repairs, the advancement of the damaged complex was relatively easy in a L-L complex detachment type, while the separation of L-L complex from the fragment was necessary in a small bony fragment type. Anatomical repairs were not possible in the remaining 2 types.
This classification is based on the localization of failures of anterior supporting strutures including ligament, labrum and bone, and is applicable for the evaluation of intraarticular findings and postoperative assessment of traumatic antertior dislocations and subluxations.
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Hideki TOMIOKA, Teruhiko NAKAGAWA, Makoto TANAKA, Yoshinari UCHIDA, Ma ...
1996 Volume 20 Issue 2 Pages
299-302
Published: November 30, 1996
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[Purpose]
The purpose of this study was to estimate the clinical results of Caspari's procedure for traumatic anterior instability.
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(Return to Sports Activities)
Masashi KAMIHIRA, Tomomitsu KUTSUMA, Takashi TSUCHIYA, Hiroshi SEKI, J ...
1996 Volume 20 Issue 2 Pages
303-305
Published: November 30, 1996
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We performed a modified Bristow's procedure (May) for traumatic anterior instability of the shoulder. We also investigated the return to sports activities.
Thirty shoulder joints of 30 patients, composed of 18 cases of traumatic anterior dislocation and 12 cases of subluxation were examined.
All the patients had hoped to return to either contact sports (16 cases) or throwing sports (14cases).27 male and 3 female patients were treaed.
18 cases were treated on the right shoulder and 12 cases on the left.
The average age of the patients at the time of operation was 22. The follow-up period ranged between 12and 216 months with an average of 66 months. We investigated sports activities, range of external rotation of the shoulder joint and then implemented the shoulder scoring system devised by the Japanese Otrhopaedic society (JOA score).
In all the cases, there was no dislocation and subluxation observed after the operation. In contact sports,14 cases returned to their previous sport activities and 2 cases changed to another sport. In throwing sorts,13 cases returned to their previous ones and only 1 case changed to another one. However,5 out of those 13 cases could not throw with their maximum ability. In these throwing sport cases, the range of external rotation on the operated side was restricted by 10.7 degrees in comparison to that of the other side. On the other hand, in the contact sport cases, the range of external rotation was restricted by only 4 degrees. The mean JOA score were 98.3±19 points in contact sport cases and 95.7±3.1 points in throwing sport cases postoperatively.
The results of the modified Bristow's procedure (May) were evaluated as being excellent for those athletes in contact sports.
However, the results for those athletes in throwing sports showed a reduction in their maximum performance. (299 words)
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Tadashi TOMONAGA, Nobuyuki ITO, Masao ETO, Shinichi HARADA, Katsuro IW ...
1996 Volume 20 Issue 2 Pages
307-311
Published: November 30, 1996
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Many operative methods for recurrent anterior shoulder dislocation have been reported on. Since 1967, we have carried out modified Bristow procedure for the treatment of recurrent anterior shoulder dislocation. The purpose of this report wae to investigate the clinical results of this procedure.
71 shoulders of 70 patients were followed-up.57 patients were male and 13 patients were female. The right shoulder was affected in 35 cases and the rest of the 36 shoulders were on the left side. The follow-up period ranged from one year to 17 years and one month, with a mean of four years and eight months.
The objective results were examined according to the shoulder evaluation sheet of the Japanese Orthopaedic Association (JOA) and also by the Carter Rowe's criteria. In our series, the redislocation rate was 5.6%. The mean loss of external rotation was 9.4 degrees. The average JOA score was 93.9 points.63shoulders(88.7%) had 90 points or more. Rowe's criteria had excellent results for 73.2%, goog for 18.4%, fair for 2.8% and poor for 5.6%. From the aforementioned results, We believe that a satisfactory result can be achieved by using a modified Bristow procedure for the treatment of recurrent anterior shoulder dislocation.
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Tomohiro TANABE, Atsushi HIGASHI, Isamu HARA, Kazuya TAMAI
1996 Volume 20 Issue 2 Pages
313-316
Published: November 30, 1996
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We evaluated 71 shoulders of 71 patients (57 males and 14 females) Who had had an open Bankart repair for recurrent anterior instability of the shoulder. Forty patients were operated on using Rowe's modification,12 with Statak, and 19 with a Mitek G II anchor device. Sixty of the 71 patients had been engaged in athletic or recreational sport activities preoperatively.
The postoperative functional results were assessed 0.5-6.9(average,2.8)years after surgery, using Rowe's rating system and Takagishi's scoring sheet for sporting ability derived from Japan Shoulder Society.
Overall, a dislocation recurred in 5 of the 71 shoulders. Rowe's scores ranged from 15 to 100(average,87)with excellent and good results in 61 patients. No patients who had had a Rowe-modified Bankart operation showed any recurrence of the dislocation. Contrastingly,4 of the 12 patients operated with Statak had a redislocation, postoperatively, of which 3 showed incomplete insertion of the device into the bone. There was one resubluxation in the patients operated on with a Mitek, although the other 8 were ranked as either excellent or good. The results of Takagishi's scoring indicated that the athletic performance did not change postoperatively, irrespective of the operative procedure, if the patient could return to his sport without fear of a redislocation.
We conclude that the proper placement of an anchor device is most important when using it in a Bankart operation, which is also true in an arthroscopic Bankart repair.
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Kenji HAYASHIDA, Minoru YONEDA, Atsushi HIROOKA, Shigeyuki WIKITANI, K ...
1996 Volume 20 Issue 2 Pages
317-320
Published: November 30, 1996
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Purpose
To clarify the effectiveness of our Bankart procedure augmented with coracoid transfer (Bankart &Bristow procedure) for traumatic anterior shoulder instability in contact athletes.
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Sunao FUKUSHIMA, Kenji OKAMURA, Mitsuhiro AOKI, Masashi NAGAMORI, Seii ...
1996 Volume 20 Issue 2 Pages
321-327
Published: November 30, 1996
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Purpose: The purpose of this study was to evaluate the clinical results of surgical treatment for recurrent posterior glenohumeral instability.
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Mitsukuni YAMAGUCHI, Hiroaki TSUTUI, R. YAMAMOTO, K. MIHARA, S. HOKARI ...
1996 Volume 20 Issue 2 Pages
325-328
Published: November 30, 1996
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Purpose
We investigated the muscle strength of the scapulothoracie joint which is apt to be affected by the position of other joints.
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Naoki SUENAGA, Akio MINAMI, Katsunori SUZUKI, Hiroyuki KATO, Makoto KO ...
1996 Volume 20 Issue 2 Pages
329-332
Published: November 30, 1996
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Although labrum injures of the shoulder are a common problem in a shoulder sports injury, their preoperative diagnoses are somewhat difficult. The purpose of our study was to clarify whether a labrum injury of the shoulder can be diagnosed by severa clinical examinations. Labrum injuries of the shoulder were diagnosed artrroscopically in 15 patients. There was no history of shoulder dislocation or subluxation present in any of the patients. The correlation between the arthroscopic findings and the preoperative clinical findings was evaluated. In 12 cases with a superior labrum injury, the clunk test was positive in 10 cases. The anterior apprehension test and the relocation test were positive in 10 cases (5 cases with anterior ahoulder pain and 5 with posterior pain). In 5 cases with anterior ahoulder pain at relocation test,4 cases had a Bankart's lesion. In 5 cases with posterior shoulder pain at relocation test, all the cases had a buttered rim of the posterosuperior portion of the labrum. The clunk test and the relocation test are both very useful means to diagnose a labrum injury of the shoulder.
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Hideo KUMAGAI, Motohiko MIKASA, Makoto TANAKA, Teruhiko NAKAGAWA
1996 Volume 20 Issue 2 Pages
333-335
Published: November 30, 1996
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Recently MR imaging has enabled non-invasive examination of rotator cuff lesions. We investigated rotator cuff lesions of athletic shoulders at MR imaging. Forty-four patients who had symptoms and signs suggesting rotator cuff lesions of athletic shoulders were selected. T1-and T2-weighted images were obtained in the oblique coronal plane. Oblique sagittal images were also obtained in some patients. Changes of the signal intensity on the supraspinatus tendons and an effusion in the bursa and joint space were examined. Increased signal lesions on T1-weighted images were observed in of all the 44 patients. Increased signal lesions on T2-weighted images were observed in all the 44 patients. Increased signal lesions were observed in the posterior part of the supraspinatus tendon.
Effusion the subacromial bursa and the joint space were observed in 21 and 25 patients respectively. We believe MR imagings are useful in examining rotator cuff lesions of athletic shoulders.
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Hiroaki TSUTSUI, Mitsukuni YAMAGUCHI, Ryuji YAMAMOTO, Kenichi MIHARA, ...
1996 Volume 20 Issue 2 Pages
337-340
Published: November 30, 1996
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[Purpose]
Cuff exercises are usually performed to improve the shoulder function and to keep the condition of the shoulder of throwing athletes. Thus, there are a large number of athletes who could not acquire the expected effects of the exercises. In this study, we examined the estimation of the cuff function and the daily exercises of the athletes electromyographically.
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Masao KUROKAWA, Kunihiko YANAGA, Yasusuke HIRASAWA
1996 Volume 20 Issue 2 Pages
341-343
Published: November 30, 1996
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The resulrs of 20 consecutive patients with incomplete rotator cuff tear due to sports activity who underwent artroscopic surgery including resection of coraco-acromial ligament (RCA) and arthroscopic aubacromial decompression (ASD), or open rotator cuff repair (OCR) were evaluated.
Fifteen male and 5 female were studied. The mean age was 28 years; rang ing from 15 to 49years.
Affected side was right in 18 patients and left in 2; all patients were affected on the domin ant side. ASD was performed in 11 patients and RCA in 4 patients with Snyder's grade 1 or 2 incomplete tear of rotator cuff, and OCR was indicated in 5 with Snyder grade 2or 3. Patients were evaluated postoperatively based on the Japanese Orhtopaedic Association shoulder rating score (JOA score) and sports score in shoulder (sports score). Excellent was over 90 points, good was over 80 and under 90, fair was over 70 and under 80 and poor was under 70.
JOA score impr oved in all patients with arthroscopic surgery or open rotator cuff repair.
Sports score improved in 8 of 11 patients with ASD, average of 92.8 points post-oper atively, in 3 of 4 with RCA, average of 93.8 and in all patients with OCR, average of 94.0. Eleven of 15 patients with arthroscopic surgery (73.3%) and all patients with OCR (100%) returned to competition on same level.
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Kenji TAKAGISHI, Akihiko SAITOH, Akihiko NISHIMURA, Masatoshi TONEGAWA ...
1996 Volume 20 Issue 2 Pages
345-348
Published: November 30, 1996
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We wish to report on eight cases of isolated paralysis of the infraspinatus and discuss the diagnosis, pathology, treatment, and outcome. The diagnosis of isolated paralysis of the infraspinatus was mede from a combination of clinical and EMG findings in all the cases. The patients were all male with a mean age of 32 years and six had been sportsmen for at least five years. Examinations revealed atrophy of the infraspinatus and weakness of external rotation and abduction in all of the cases.
Five patients with a tenderness over the spinoglenoid notch were all later found to have space-occupying lesions using an MRI and ultrasound. An ENG showed isolated paralysis of the muscle. Ultrasound or an MRI revealed a space-occupuing lesion near the base of the spinoglenoid notch in five cases. Three of the patients with cystic space-occupying lesions had operations after at least three months of conservative treatment and ganglia were found. They recovered uneventfully. The remaining five were treated conservatively and returned to normal. Isolated paralysisi of the infraspinatus due to ganglia is not uncommon as thought previously. An MRI and ultrasound can determine the diagnosis and location of any ganglion and also assess the status of the rotator cuff.
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Ali KONDO, Toshiyasu FUJIWARA, Toshiyuki WAKABAYASHI
1996 Volume 20 Issue 2 Pages
349-352
Published: November 30, 1996
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Snowboarding has been expanding dramatically in popularity, and shoulder injuries are increasing in ski resorts. We estimated the incidences and patterns of snowboarding injuries in the 1995 winter season in Minamiuonuma, and compared them with the skiing injuries at our hospital during the eight skiing seasons (1988-1995). The antatomical distributions and the types of injuries in snowboarding differed from those in alpine skiing. Comparing skiers' versus snowboarder's injuries, snowboarders had more injuries to the upper limbs (47% versus 23%), and fewer injuries to the lower limbs (24% versus 50%). Snowboarders had 1.6times as many injuries of their left sides as those of their right sides. There were 109 cases of shoulder injuries out of 613 cases of snowboarding injuries, and 245 cases of shoulder injuries out of 1822 cases of skiing injuries. In snowboarding 18% of shoulder injuries occurred in novices (first trial ) and 27% occurred in beginners, and in skiing 5% of shoulder injuries occurred in novices (first trial) and 19% occurred in beginners. The common locations of shoulder injuries were the glenohumeral joints (51% in snowboarding and 53% in skiing), the clavicles (23%,13%), acromioclavicular joints (6%,9%) and the proximal end of the humerus (3%,11%). In the ‘MK’ ski resort, snowboarders had four times as many injuries as skiers (0.583% versus 0.146%). To prevent injuries in snowboarding, especially beginners should use protective devices for their shoulders.
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Kazuyuki SEMPO, Masao KUROKAWA, Taku YAMASHITA, Yasusuke HIRASAWA
1996 Volume 20 Issue 2 Pages
353-356
Published: November 30, 1996
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The purpose of this study is to clarify the different isokinetic strengths in a recurrent anterior dislocation and subluxation of the shoulder.
Twenty-four shoulders with recurrent anterior dislocation and 13 shoulders with recurrent anterior subluxation were examined. The average peak torque per body weight(N. m/Kg) at 90 deg/sec. and total work per body weight(J/Kg) at 180 deg/sec. were measured with a LIDO active system and the dislocations were compared with the subluxations statistically.
The average peak torque per body weight(N. m/Kg) of the dislocations was lower in value(P<0.05) in the involved side than in the uninvolved side on flexion(0.52/0.61) and on external rotation(0.33/0.37) and total work per body weight(J/Kg) was also lower in value(P<0.05) on flexion(9.2/10.5), otherwise they were equivalent to the subluxations.
A decrease of isokinetic strength of a dislocation was may be due to an apprehension for dislocation but many other factors may participate in the performance of the musclesmaking further consideration necessary.
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Junko YAMAGUSHI, Masao KUROKAWA, Kunihiko YANAGA, Yasusuke HIRASAWA, M ...
1996 Volume 20 Issue 2 Pages
357-360
Published: November 30, 1996
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The diagnosis of anteroposterior instability of the shoulder should be based on physical examination because there are no definite radiographs which show the degree of the instability.
For the purpose of evaluating the usefulness of ultrasonography for the quantitative evaluation of anteroposterior instability of the shoulder, twenty seven shoulders of fourteen volunteers ranging from 20 to 39 years old (average,27.8) were examined.
With a 3.5MHz sector scanner (Yokokawa), transverse scans were obtained using the posterior approach. The shoulder was placed at resting position with neutral rotation. The difference between the respective distances from the probe to the humeral head and to the glenoid (GHD) were measured with and without a manual posterior load. Utrasonograms with a load were obtained when the humerus migrated posteriorly at the maximum. The measurements were repeated 5 times in each condition.
The GHDs were O.82±0.31cm(mean±SD)without a load and 1.96±O.53cm with a load, respectively. The posterior migration of the humeral head by a load was1.13±0.53cm.
The posterior migration of the humeral head of the right shoulder and the left one should no significant differences.
The variance of GHD with a load was larger than without a load. The standard deviation of 5 values of each shoulder with a load were extremely large in four examinees.
The reasons of variance were thought to be that the load was not suitable to move the humerus maximally, and that it was difficult to obtain clear ultrasonograms of well built people especially with a load.
We believe in the usefulness of an ultrasonography even though there are still some problems to solve for better results.
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Michimasa UI, Kiyohisa OGAWA, Wataru INOKUCHI, Toyohisa NANIWA
1996 Volume 20 Issue 2 Pages
361-364
Published: November 30, 1996
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To evaluate the depiction of a Hill-Sachs lesion, the findings of a plain X-ray, pneumoarthro CT and operation(surgical) findings were compared.
There were 141 patients,1 43 shoulders(male; 125 shoulders, female; 18 shoulders) with anterior glenohumeral instability. The average age at the time of the operation was 24 years old(15 to 60 years). In conventional views and the 45° craniocaudaI view, the notch, translucency and cystic region in the postero-1ateral site of the humeral head were estimated as a Hill-Sachs lesion. In a pneumoarthro CT, the notch and irregular region were, estimated the same.
Palpation at time of operation w as used to certify a Hill-Sachs lesion. Hill-Sachs lesion were certified in 136cases(95.1%) by palpation. In a conventional view, the A-P internal rotational view showed a Hill-Sachs lesi on with a rate of 58.1%, while the rate using the 45° craniocaudal view was 96.3%.
A pneumoarthro CT precisely revealed a Hill-Sachs lesion, Of the conventional views, the 45° craniocaudal view was the most beneficial.
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A Preliminary Report
Hirokatsu HANAMURA, Takahiro MIZUNO, Norimasa YASUHARA, Hiroshi MAEDA, ...
1996 Volume 20 Issue 2 Pages
365-369
Published: November 30, 1996
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Twenty cases of traumatic anterior instability of shoulder joints(recurrent dislocation: 14 cases, initial dislocation: 6 cases) were treated with arthroscopic bioabsorbable tack stabilization technique(Suretac device).
There were 7 cases of recurrent dislocation and 2 cases of initial dislocation with over 1 year postoperative follow-up(range,12 to 19 months). Among these 9 cases a single episode of recurrence has occurred in one of recurrent dislocation case who had returned to play an American football 6 months after his operation. All the high athletes with an initial dislocation(an American footballer and a basketball player) have been able to return to their preinjury performance levels.
The key for a satisfactory result is seemed to be patient selection; unidirectional, fewer frequencies of recurrence no retracted Bankart lesions with a robust capsulolabral complex and no neurologic injuries. The best indication is an initial dislocation in which no attenuation or degeneration has been seen yet.
This fixation technique is considered to be advisable because there is no risk of iatrogenic neurovascular injury, no technical difficulty and less morbidity.
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Hiroyuki TERASHI, Tatsuhiko TANIZAWA, Hiroyuki SHIOZAKI, Tatsuzi KOBAY ...
1996 Volume 20 Issue 2 Pages
371-374
Published: November 30, 1996
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The clinical results of a glenoid osteotomy for an unstable shoulder may depend on the various states of each patient. This is a follow-up study to evaluate the efficacy of glenoid osteotomy.
Ten shoulders of 8 patients: Five men,3 women aged 14-35 years(mean 21) underwent a glenoid osteotomy during the 11 years(1981-1991) at our university hospital or sffiliated hospitals.
The follow-up period was from 8 months to 9 years(mean 3 years). Two patients showed bilateral in volvement. All patients were evaluated by chart review. Also the preoperativeand postoperative radiographs were available.
Physical examinations were carried out on the last day of the follow-up period.
Results: Persistent instability was recognized in 3 shoulders(2 cases) and contracture of the joint was found in 2 shoulders which required additional surgery.
The rest of the five shoulders(4 cases) gained an excellent recovery in their joint function. Two cases could return to their previous levels of sport.
Conclusion: Proper indications for a glenoid osteotomy seemed to be for those who had aslipping on elevation and glenoid dysplasia.
The lack of these functional and anatomical abnormarlities required an additional operation.
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Kunihiko YANAGA, Masao KUROKAWA, Yasusuke HIRASAWA, Hideyuki TAKESHITA
1996 Volume 20 Issue 2 Pages
375-378
Published: November 30, 1996
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In aged patients an initial anterior dislocation of the shoulder produces a rotator cuff tear and sporadically advances to a recurrent anterior dislocation(RAD). Two cases of aged RAD with rotator cuff tears(case 1; a 70-year-female case 2; an 80-year-female) were reported in this paper.
These cases were treated surgically. The operative findings were large Hill-Sachs lesions and rotator cuff tears without a Bankart lesion. The middle and inferior glenohumeral ligaments were torn at the attachment of the humeral head in case 1 and the mid substance in case 2. The middle and inferior glenohumeral ligaments-labral complex were intact in each case. In case 2, the subscapularis tendon was ruptured and the long head of the biceps tendon was dislocated.
The operative findings mentioned above were not found in young patients with an RAD. The substance tear of capsular ligaments is a cause of recurrence and an important factor in aged RAD with a rotator cuff tear.
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Tohru OKUWAKI
1996 Volume 20 Issue 2 Pages
379-382
Published: November 30, 1996
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A Case Report
A 24-year-old man was injured while playing rugby. He tackled with his left arm and his pectoralis major muscle with a hard eccentric contraction. He started to feell pain across his bust and left arm and could not elevate his arm.
He was treated conservatively, but he constantly felt his left pectoralis major muscle painful whenever he tried to use it.
After one year, he had a characteristic posture. When he tried to contract his left pectoralis major muscle, his left axilla had a webbed appearance and the muscle shifted proximally. At the same time, he felt extreme pain.
Surgical repair was carried out. The attachment of the left pectoralis major muscle was detached and adhered to the fascia of the upper arm. The tendon was reattached to the humerus with non-absorbable sutures.
After two months, his shoulder had regained full range of motion. He retuned to playing six months later.
Distal ruptures of the pectoralis major muscle under tension are reparable, even after a delay in treatment.
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Yoshiyasu YAMAGUCHI, Koh MARUYAMA, Yasuhide IMAMURA, Hideo MASUBUCHI, ...
1996 Volume 20 Issue 2 Pages
383-387
Published: November 30, 1996
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Kaschin-Beck disease, an endemic disease which occurs mainly in Heilungjiang Provjnce of the People's Republic of China, causes multiple and symmetric degeneration and necrosis in the articular and epiphysial cartilages and subsequent secondary osteoarthritis. The effects of the disease are observed throughout the body, but it is rare for the shoulders to be affected. In this study we report two patients with the disease and degeneration in the joints who had spent their childhood in the province and came back to Japan.
Case 1 is a 46-years old female who had lived in Heilungjiang province from birth to 41 years.
X-ray examination showed osteoarthritis in the metacarpo-phalangeal(MP) and carpometacarpal(CM)joints of the hand, as well as in the wrist, elbow, knee, ankle joints. We also confirmed cartilaginous radiolucent lesion in the heads of both humeri. MRI of the shoulders revealed necrosis in the heads of both humeri.
Case 2 is a 48-years old male who had lived there from birth to 43 years. X-ray showed osteoarthritis in the distal and proximal interphalangeal (DIP)(PIP), MP and CM joints of the hand, wrist, elbow, knee, and ankle joints, but no marked change in the shoulders. However, MRI revealed the necrosis in the head of the humeri as in the case 1.
Although Kaschin-Beck disease, is a systemic joint disease caused by cartilage metablic disorder, involvement in the shuolders has rarely been reported. However, as our case 2 shows degeneration in the shoulder joints was detectable only by MRI, not by X-ray examination. Consequently we consider this disease should be carefully observed.
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-Operative treatments-
Mitsuaki NODA, Hidenori SHIRAISHI, Kosaku MIZUNO
1996 Volume 20 Issue 2 Pages
389-392
Published: November 30, 1996
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Dislocation of the sterno-clavicular(S-C) joint is an uncommon injury, especially posterior dislocation is rare and often accompanied by severe complications. We encountered a posterior S-C dislocation causing the compression of subclavian artery.
A 23-year-old male with a motor bike accident, was admitted to our institute in April 1992. Upon examination, his shoulder injury was regarded as a sprain by means of radiographs. As the pain at left-S-C joint, and the coldness and sensory disturbance at the upper extremity while elevating the arm persisted, a thorough examination revealed a posterior dislocation of medial end of the clavicle. Hyperabduction test was positive without exhibiting any motor or sensory deficit. In September 1992, open reduction was performed with the stabilization of the palmaris longus tendon graft, and resulted in redislocation and recurrence of the symptom within 2 months. In July 1994, reconstructive procedures both intra- and extra-articular were performed. Despite the upper transposition of the clavicle,10 months postoperatively, his activities are uneventful.
Anatomically S-C joint stability is chiefly maintained by ligaments or surrounding soft tissue. In the chronic dislocation the tissue is so severely damaged that these three alternative methods for surgical intervention are performed; arthrodesis, partial resection of medial clavicle, and reconstruction with a ligament or tendon graft. The arthrodesis is not commonly done for inducing a diminished shoulder range of motion. And the partial resection may occasionally be recommended to use except for heavy manual worker. There are various techniques for the reconstruction. Since a stable joint should be required, we performed the reconstruction boht intra-articularly with allograft and extra-articularly with auto sternoclavicular tendon. Thereafter further observation would be suggested.
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a Case Report
Hiroshi SEKI, Tomomitsu KUTSUMA, Masashi KAMIHIRA, Takashi TSUCHIYA, J ...
1996 Volume 20 Issue 2 Pages
393-396
Published: November 30, 1996
Released on J-STAGE: November 20, 2012
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We reported on a case of post-traumatic osteolysis of the distal end of the clavicle in a judo athlete. The case was a 17-year-old high school student who had participated in judo for nine years. Left shoulder pain occurred after he fell on his shoulder. The shoulder radiography was normal at first, four months after the injury, characteristic resorption of the distal end of the clavicle was found. On physical examination there was local tenderness, but no instability and swelling in the acromioclavicular joint. Range of motion of his left shoulder was not restricted. Despite conservative treatment, including nonsteroidal anti-inflammatory medication and limitation of sports activities, shoulder pain persisted. As a cortical thinning or irregularity of the distal clavicle had progressed on X-ray, open surgical excision of the distal clavicle was performed. There was no cartilaginous disc and the space between the acromion and the clavicle had been substituied by granulation tissue. Histologic examination showed metaplastic bone formation with increased osteoclastic activity and no evidence of inflammation. Osteolysis of the distal end of the clavicle is a rare condition, which it can occur during judo.
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Koji KANEKO, Jun-ichiro FUJIKI, Shigenori YOSHIMOTO, Jiro OZAKI
1996 Volume 20 Issue 2 Pages
397-399
Published: November 30, 1996
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We recenly experienced a case of posttraumatic osteolysis of the distal end of the clavicle due to malunion of a fracture. Our surgical treatment of this patient was a succes.
A 38-year-old-man had been complaining of left ahoulder pain since Aprol,1995. At the initial examination, the patient was suffering from tenderness and pain whenerver he elevated his left arm. Using radiology, we noticed a deformity of the clavicle due to the malunion of a fracture suffered 20 years before, and an osteolytic change in the distal end of the clavicle. Preoperative MRI findings showed a hypertrophic change of the A-C joint capsule, with an effusion inside. Sinec the patient's condition could not be improved without surgery, We performed a resection of the distal end of the clavicle. At operation, the capsule was thickened, we noticed hyperplasia of synovia. The cortex at the distal end of the clavicle was fragile. The histopathological studt ahowed an erosion of the articular cartilage and hyperplasea of synovia. After surgery, the pain had deen reduced and the patient was regaining a full range of motion of his left shoulder. And now, he has returned to his original job.
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-2 Case Reports-
Masahiko KOMAI, Gentaro KINOSHITA, Hiroomi TATEISHI, Souji MARUO
1996 Volume 20 Issue 2 Pages
401-405
Published: November 30, 1996
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Purpose
Intra-osseous ganglia are tumor-like lesions that usually occur in juxta-articular subchondral areas of hip joints knee joints and so on. Lesions occuring in close relationship shoulder joints are rare. Two cases of the shoulder are reported here.
Case 1
A 16-year-old girl presented with right shoulder pain. The range of motion of the right shoulder was slightly limited and tenderness on the great tubercle was there.
A plain X ray film revealed a round radiolucent area in the proximal epiphysis of the right humerus. The computerized tomogram showed a low density area rimmed by a high density line. Magnetic resonance imaging film discovered a low intensity by a T1 weighted image, a high intensity by a T2 weighted image and no response to a gadolinium injection. Gelatinous material was found in the cavity underlined by a fibrous connective tissue.
Case 2
A 40-year-old man came with left shoulder pain after playing golf. A plain X ray film showed a multilobular radiolucent area in the glenoid of the left scapula. The computerized tomogram and MRI revealed the same findings as in Case 1. Both the macroscopic findings and the microscopic findings were the same as in Case 1, too.
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-A Case Report-
Nariyuki MURA, Yasuo GOTOH, Masahiko MATSUDA, Yosihiro WATANABE
1996 Volume 20 Issue 2 Pages
407-410
Published: November 30, 1996
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We wish to report on a rare case of chronic synovitis with loose bodies in the gleno-humeral joint.
A Case Report
A 24-year-old man visited Kahoku hospital in August 1994, complainning of pain and limitation of movements in this left shoulder. A plain X-ray revealed no abnormal findings, but an arthogram and MRI showed loose bodies in the gleno-humeral joint. The laboratory findings were normal. We diagnosed this case as synovial chondromatosis, and performed an arthroscopy and total removal of the loose bodies in December 1994. Fifteen loose bodies ranging from 10-30mm in size were removed, and synovial biopsy was performed at the same time. He complained of nothing three months after surgery.
The histological findings
Loose bodies were glittering, whitish, elastic soft, and various types of shapes, such as a sphere, a club and a sickle, were observed. Neither chondral nor osteochondral formations were detected in the loose bodies. The superficial layers consisted of lining cells such as synovial membrane, whereas the core was degenerative or hyalinized. Inflammatory cell infiltration and villus hyperplasia were observed in the synovial tissue.
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(Using 3 Dimensional Analyzing System)
HASHIMOTO Yushi, TSUKANISHI Shigeaki, KANATANI Yoshiaki, [in Japanese] ...
1996 Volume 20 Issue 2 Pages
411-414
Published: November 30, 1996
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Purpose
The relationship between body and shoulder rotation during the throwing motion was studied using a 3D analyzing system.
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Mototsune MURAKAMI, Masaaki KOBAYASHI, Gen-itsu YOSHIKAWA, Ryu TARUMOT ...
1996 Volume 20 Issue 2 Pages
415-419
Published: November 30, 1996
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Among shoulder pain caused by a sports injury in the younger generation, there is the disease little league shoulder(LLS), which this study discusses.
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Katsumasa SUGIMOTO, Huminori FUJIYOSHI, Shinji YOGO, Toshiharu OKUDA, ...
1996 Volume 20 Issue 2 Pages
421-425
Published: November 30, 1996
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Abstract
We have used ultrasonography as the diagnostic equipment of a throwing injury in the shoulder joint since 1987. In this report, we evaluated its usefulness in the diagnosis of shoulder joints injured by the throwing activity.
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Yoshinori TAKUBO, Kunihiko YANAGA, Motoyuki HORII, Masao KUROKAWA, Yas ...
1996 Volume 20 Issue 2 Pages
427-430
Published: November 30, 1996
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The purpose of this study is to clarify the factors of painful shoulders in throwing athletes using MR imaging.
Using MR imaging,22 shoulders(18 males and 4 females, ranging in age from 15 to 35 years, average 22.0years, right 20 and left 2) were examined. They all had pain in throwing or overhead motion of the shouldes(baseball and softball-13, volleyball-4, tennis-4, and other-1). Oblique coronal sections (scapular plane)or axial sections were obtained with mainly T2* weighted sequences. The changes of the rotator cuff and the humeral head were evaluated.
On T2* weighted images, the supraspinatus tendon changed into diffuse or spotty high signals in 15 of the 22 shoulders. Eight of the 22shoulders(31.8%) showed high cystic signals at the posterosuperior lesion of the humeral head on T2*s.
In painful shoulders of throwing athletes, not only the rotator cuff but also the humeral head changed on the MR imaging scans. Recently, the idea of a posterosuperior impingement has been reported. We speculate the change is caused by an impingement between the humeral head and the posterosuperior labrum.
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- Evaluation using MR Arthrography and MRI-
Kazutaka IZAWA, Kenji HAYASHIDA, Minoru YONEDA, Shinya NAKASATO, Atsus ...
1996 Volume 20 Issue 2 Pages
431-434
Published: November 30, 1996
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[Purpose] We compared MR arthrography (MRA) and MRI for the detection of abnormalities of the superior glenoid labral detachment.
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Jun HASHIMOTO, Takumi NAGAI, Hitoshi TERUYA, Katsuya NOBUHARA
1996 Volume 20 Issue 2 Pages
435-439
Published: November 30, 1996
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131 shoulders of 131 baseball players were examined by radiograph on AP view in the Zero position. The FSH angle, angle of the gleno-scapular spine and the angle of the humero-scapular spine were measured. The patients were classified into three groups of Bennett lesion. Group A had a Bennett lesion which was on or close to the glenoid (32 shoulders). Group B had a Bennett lesion which was at the inferior of the glenoid (7shoulders). Group C did not have a Bennett lesion(92 shoulders).
The FSH angle showed 72.8±5.3(A),92.3±7.5(B) and 86.6±9.4(C). The angle of the gleno-scapular spine ahowed 83.5±5.3(A),83.1±6.7(B) and 80.3±5.2(C), Angle of humero-scapular spine ahowed 179.3±7.9(A),184.9±6.5(B) and 185.3±7.4(C). There was a statisitcal significance between groupA and groupC in all measurements. The percentages of the positive slipping phenomenon was over 85 degrees in the FSH angle were 0% in groupA,86% in groupB and 64.1% in groupC.
In groupA, the slipping phenomenon could not be observed as in groups B and C. In addition, there was a significant increase of the angle of the gleno-scapular spine and a decrease of the angle of the humero-scapular spine, which meant a stabilization of the glenoid and limitations of hypermobility of the gleno-humeral joint.
According to our results, Bennett lesions which were close to the glenoid could contribute to the dynamic stability of the shoulder functionally.
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Mikihiko WATANABE, Hidefumi HIROSE, Takeshi OGAWA, Takashi SHIRATO, Yu ...
1996 Volume 20 Issue 2 Pages
441-444
Published: November 30, 1996
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(Summary)
Shoulder pain is one of the most common complaints among baseball picthers. MRI and arthroscopy give a lot of useful information about the capsule. This study attempts to clear the pathomechanics of a throwing shoulder by comparing the symptoms and the findings of MRA and arthroscopy.
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Gen-itsu YOSHIKAWA, Ryu TARUMOTO, Sinsuke HUKUDA, Mototsune MURAKAMI, ...
1996 Volume 20 Issue 2 Pages
445-450
Published: November 30, 1996
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Posterior shoulder pain is sometimes observed in throwing athletes. This occurs in one of two ways: from extraarticular neurological problems, or from intraarticular posterior lesions which include posterior labrum injuries as well as the joint side tear of the rotator cuff. The purpose of this study is to evaluate the intraarticular posterior lesions of the shoulder in cases of throwing athletes.
Seven baseball players who had posterior shoulder pain underwent arthroscopy. The mean age was 20.1years. History of their present illness, physical examinations and some diagnostic imagings were evaluated in comparison with the arthroscopic findings.
In most of the patients, the shoulder position producing pain was 90 degree abduction and full external rotation. There were no consistent findings in the physical examinations. Plain roentgenograms showed a posteroinferior ossification of the glenoid (Bennett lesion) in five cases. The arthroscopic study revealed posterior labrum injuries in five cases, joint side tears of the rotator cuff in 5 cases. There were no SLAP lesions or Bankart lesions. These intraarticular posterior lesions seemed to correlate with the posterior glenohumeral impingement phenomenon.
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Kiyohisa OGAWA, Michimasa UI, Wataru INOKUCHI, Toyohisa NANIWA
1996 Volume 20 Issue 2 Pages
451-455
Published: November 30, 1996
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In order to clarify the etiology and nature of a Bennett lesion,37 symptomatic cases with this lesion were analyzed clinically and radiologically. The age at onset ranged from 13-30 years old with an average 21 years old.86% of the cases felt pain in the late cocking and/or follow through phases. There was tenderness on the posterior joint space in 17 and on the bicipital groove and SSP in 6 cases.12 6, and 19 cases respectivelyfelt pain in each of the posterior drawer test, the posterior apprehension test and the anterior apprehension test. The ROM was characterized by a restriction of horizontal adduction in internal rotation. The drop arm test(two finger test) was positive in 10 cases. Pain was triggered by a forced external rotation and abduction test in 89%, and by a forced internal rotation test during 90 ° flexion in 84%. According to the radiological findings, ossifications were classified into two types; thickening(29 cases) and spike types(8cases). The thickening type was a mountain-shaped ossification rising from the glenoid rim and its proximity. The spike type indicated a spur formation from the glenoid rim growing towards the inside of the joint. Of 12 cases treated surgically,9 cases had glenoplasty and reattachment of the labrum. All 5 cases of a thickening type had detachment of the labrum with subperiosteal ossification and all 4 cases of spike type had the thickening of the labrum without a detachment.
A single structure and its pathological change that can explain the physical and surgical manifestations is a contracture of the postero-inferior portion of the IGHL. During the follow through phase a resultant traction stress is imposed on the postero-inferior labrum. If it is great enough to cause detachment of the labrum, a subperiosteal new bone formation would result. If it is not so great, a traction spur would form gradually. It is concluded that the etiology of a Bennett lesion is the contracture of the postero-inferior IGHL caused by repeated microtrauma inflicted by throwing and the resultant increase of traction stress imposed on the labrum.
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Yozo SHIBATA, Koji MIDORIKAWA, Teruaki IZAKI, Gen EMOTO, Kosuke OGATA
1996 Volume 20 Issue 2 Pages
457-461
Published: November 30, 1996
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The operative results of athletes with a spur ih the posterior surface of the glenoid are reported on here. Five shoulders of five patients were evaluated after removing a spur on the posterior surface of the glenoid. Preoperative and postoperative evaluations of the patients included subjective pain, function and patient satisfaction as well as objective assessment of the active range of motion, plane X-rays, double contrast arthrography, CT arthrography and MRIs.
The duration of the follow-up period ranged from 7 to 35 months(mean,16.8 months).
There were five men aged were from 23 to 26 years old(mean,24 years). There were three baseball players and two volleyball players, who had played their sports for an average of 12 years. Their symptom durations ranged from four to seven years(mean,5.2 years). Muscle atrophy of the supraspinatus was seen in all the patients. Axial X-ps showed all the cases had a spur, but the Bennett view revealed it in only 2 shoulders. All the patients had tenderness on the posterior joint line. A lidocaine test directly injected to the spur was effective but the injections to both the subacromial bursae and the gleno-humeral joint were not. The range of motion in internal rotation, horizontal internal rotation and horizontal flexion was limited. Those with restricted motion recovered to their postoperative states. All histological specimens showed maturated bone trabeculae. Three baseball players recovered fully more than one year after surgery, but two volleyball players showed between 70 and 80% satisfaction at 7 months after surgery. These are traction spurs for three reasons mentioned above, that is, the property of the restricted range of motion, shape on X-p and histological findings of the spur. The operation is effective for those patients whose symptoms are not relieved after conservative therapy.
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Koji MIDORIKAWA, Yozo SHIBATA, Kosuke OGATA, Masafumi HARA
1996 Volume 20 Issue 2 Pages
463-467
Published: November 30, 1996
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(Purpose)
Throwing injuries of the shoulder occur as a result of overuse. Shoulder pain is experienced only during sports activities. Therefore, the diagnosis of throwing injuries of the shoulder is often difficult.
The purpose of this study is to investigate the effectiveness of arthroscopic dbridement for a throwing injury of the shoulder.
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Kimitaka FUKUDA, Satoru KAGEURA, Takehiro TAKEBAYASHI, Naomi SAWADA, H ...
1996 Volume 20 Issue 2 Pages
469-474
Published: November 30, 1996
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Since 1985, we have been practicing precise clinical examinations and sequential systematic arthro-bursographies in which 66 posterosuperior labral lesions were diagnosed as the main lesion of shoulder pain in a throwing injury. Surgical treatment was performed on 17 patients with a labral lesion. Arthroscopic resection of the torn or detached labrum alone was performed on 13 patients. Stapling of the labrum was done in one case. Resection of the labrum and the subacromial decompression was combined in 3 patients. All of the patients were male baseball players. Their ages ranged from 16 to 31 years old. The average follow-up period was 36.6 months.
Throwing pain in the late-cocking phase diminished in all the patients, postoperatively. In 3 out of 5 pitchers and 10 out of 12 fielders, the level and the speed of their pitching and throwing returned to the same levels as before injuries. To define the main lesion of throwing pain was most important when a surgical treatment was considered. The results of the arthroscopic resection of a torn and detached labrum were satisfactory, however, re-injury of the remaining labrum was of great concern.
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Minoru YONEDA, Shigeto NAKAGAWA, Shinya NAKASATO, Atsushi HIROOKA, Ken ...
1996 Volume 20 Issue 2 Pages
475-478
Published: November 30, 1996
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To clarify the efficacy of arthroscopicall assisted surgical treatment of the painful throwing shoulder syndrome, we retrospectively studied 116 baseball players followed up for more than one year postop. All the patients underwent examinations under anesthesia and arthroscopy preop. Artroscopic surgery alone was performed on 92 patients, a combined arthroscopic and open surgery on 15, and open surgery alone on nine.
At follow-up, the throwing pain was reduced in 88% of the patients and 42% were pain-free. However, only 31% showed a complete recovery of their prinjury throwing power, while 39% achieved 70-80% recovery. Eighty-four percent of the patients continued to play baseball at some level and 47% returned to their preinjury level. However, only 31% of the 45 pitchers returned to their previous level and 20% played at a lower level. The arthroscopic resection of a Bennett lesion (Bennett-plasty) provided the most excellent recovery in the pitcher group. On the other hand, the joint stabilization procedures did not show a good recovery in the pitchers although it did so in the fielders.
In conclusion, more studies of the pathology of a painful throwing shoulder as well as new diagnostic and treatment methods are necessary to improve the outcome.
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Kenzi OKAMURA, Sunao FUKUSIMA, Mituhiro AOKI, Siichi ISHII, Masamichi ...
1996 Volume 20 Issue 2 Pages
479-482
Published: November 30, 1996
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We investigated the clinical results of surgical treatment of throwing shoulders.
Fifteen throwing shoulders have been operated in the past seven years. They consisted of six high school baseball players, two college players, and seven amateur players. Subacromial decompressions was performed for impingement syndrome in 8 patients, Caspari's method for superior labral injuries in 3 patients, posterior capsulorrhaphy of Warren for posterior instability in 2 patients, a release of the axillary nerve for quadrilateral space syndrome in one patient, and resection of spur for the Bennett lesion in one patient. Postoperatively, we evaluated the degree of throwing pain and of recovery to the preoperative playing level.
Throwing pain improved in fourteen cases(93%). Recovery to baseball were obtained in fourteen cases(93%), and seven of them showed complete recovery. But only three of nine pitchers succeeded to return to the previous level.
In conclusion, throwing pain can be managed by surgical treatment if a correct diagnosis is made. However, recovery rate of the pitchers were not good as compared with that of fielders.
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Seizo YAMAMOTO, Akira NAGANO, Yoji MIKAMI, Naoyuki OCHIAI
1996 Volume 20 Issue 2 Pages
483-485
Published: November 30, 1996
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Combined injuries of the axillary and the suprascapular nerves often cause complete loss of shoulder function. To retore shoulder function, correct diagnosis and early operative repair are essential. The purpose of this study was to clarify the clinical findings of these injuries and lesions of these nerves.
Since 1984, a combined rupture of the axillary and suprascapular nerves was seen in 24 patients (23 men and 1 woman). The clinical findings were studied and the sites of the lesions of these nerves were confirmed operatively.
Clinically, the deltoid and the infraspinatus were completely paralyzed all 24 patients, and in 3 of these patients, the biceps brachii, the brachioradialis and/or the triceps brachii muscles were also weaker than M2(MRC grading), however they recovered spontaneously within a few months. Operatively, in all 24patients, the axillary nerve was injured from the point where it diverges from the posterior cord to the quadrilateral space. In most patients, the supracapular nerve was injured from the point where it diverges from the upper trunk to the suprascapular notch or to the spinoglenoid notch, and in a few patients, it was also injured at the infraspinatus motor point. Correct diagnosis and wide exploration are essential in patients with combined injuries of the axillary and the suprascapular nerves, especially the suprascapular nerve must be explored through the entire course from the point where it diverges from the upper trunk to the infraspinatus motor point, because the suprascapular nerve could be injured at multiple points.
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