Katakansetsu
Online ISSN : 1881-6363
Print ISSN : 0910-4461
ISSN-L : 0910-4461
Volume 22, Issue 2
Displaying 1-45 of 45 articles from this issue
  • Yasuaki NAKAGAWA, Yoshitaka MATSUSUE, Takashi NAKAMURA
    1998 Volume 22 Issue 2 Pages 161-164
    Published: June 25, 1998
    Released on J-STAGE: November 20, 2012
    JOURNAL FREE ACCESS
    Purpose: We have previously reported that shoulder pain was the fourth, and disability was the second problem for sumo* wrestlers. We examined sumo wrestlers directly in order to study the shoulder problems in sumo.
    Materials and Methosds: Forty-three major league Western Japan Student Sumo Federation sumo wrestlers were examined from February to April 1997. Their means were as follows: height-174.4cm,ght-106.2kg, body mass index-34.9, age -19.3 years old and length of sumo career- 9.5 years. We obtained their past histories, present disabilities, physical examination, ranges of motion and shoulder joint laxities. Results Twenty-two cases (51%) had past histories of the shoulder problems, which were 10 cases (23%) of shoulder dislocations,5 cases (12%) of contusions,4 cases ( 9 %) of acromioclavicular dislocations and so on. Seven cases (16%) had present disabilites, which were 2cases of shoulder dislocations,2 cases of acromioclavicular joint dislocations and so on. According to this study, the less heavy sumo wrestlers tended to injure and dislocate their shoulders more, and the number who complained of shoulder problems increased, with the length of sumo careers. There were no significant influences seen between the ranges of motion, shoulder joint laxities and shoulder problems.
    Conclusion: The lighter sumo wrestlers tended to injure and dislocate their shoulders more. It interfered with the wrestling of sumo, who had previously dislocated their shoulder.
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  • Tsutomu TAKIZAWA, Shaw AKIZUKI, Yukihiro YASUKAWA, Ikuya YAMAZAKI, Hir ...
    1998 Volume 22 Issue 2 Pages 165-168
    Published: June 25, 1998
    Released on J-STAGE: November 20, 2012
    JOURNAL FREE ACCESS
    Considering that the cystic changes in the heads of the humerus on MRIs of patients with a throwing injury may be ascribable to the stress fracture, we followed-up patients with such changes on MRIs to determine whether repairs occurred or not.
    The MRIs showed a low-intensity cysti c area on T1-weighted images and a high-intensity cystic area on T2 *- weighted images in 4 cases.3 of these cases were followed-up. The subjects were aged between 16 and 25 years, and the right shoulder was affected in 2 cases and the left in 1 case. They were instructed to refrain from throwing and external rotation of the shoulder from their first hospital visit. Subsequently, MRIs were repeated at intervals of about two months.
    Two patients developed symptoms after changing from a sof t baseball to a regulation one and in one patient after changing positions from second to third baseman. However, the symptoms were resolved after the initial prohibitions of throwing and external rotation in all of these patients.
    The cystic change disappeared in 1 patient, decreased in 1 patient with the ep iphyseal line. However, it remained unchanged in 1 patient without an epiphyseal line. We suggest that the cause of a cystic change was the stress fracture in cases with an epiphyseal line. However, the cause of the cystic change was a posterosuperior impingement in the case without an epiphyseal line.
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  • Tadato KIDO, Eiji ITOI, Norikazu KONNO, Akihisa SANO, Masakazu URAYAMA
    1998 Volume 22 Issue 2 Pages 169-172
    Published: June 25, 1998
    Released on J-STAGE: November 20, 2012
    JOURNAL FREE ACCESS
    The purpose of this study was to determine the in vivo function of the biceps as an active depressor of the humeral head. Thirty-eight shoulders were examined: 19 shoulders with rotator cuff tears (RCT, avg age 59 yrs) and 19 shoulders with normal MRI findings of the rotator cuff (Control, avg age 55yrs). A special arm brace which was fixed to the upper arm was used to keep the biceps in active contraction (biceps loading) during arm elevation. The subjects were asked to grasp a rubber band attached to the distal end of the brace, pull it proximally, and keep the elbow flexed against the resistant force producted by the band. The x-ray were obtained with the arm elevated at 0,45,90 degrees in the scapular plane with and without pulling the band. The center of the humeral head was determined using NTH image and compared between the groups with and without biceps loading. Without biceps loading, the positions of the humeral head at 0,45 degrees were significantly higher in RCT than those in Control (p=0.0101, p=0.0020, respectively). After loading the biceps, the humeral head was depressed significantly at each degree in RCT (P=0.0082, p=0.0259, p=0.0059, respectively). As a result of biceps loading, there were no more significant differences in the positions of the humeral head between RCT and Control (p=0.3285). The positions of the humeral head in RCT with biceps loading were similar to the positions in Control without biceps loading. This is the first study to show the in vivo function of the biceps as an active depressor. From these results, we conclude that the biceps is an active depressor of the humeral head in cuff-defficient shoulders.
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  • Goro SAKURAI, Yasuharu TOMITA, Toshinori KONDO, Tomohisa HASHIUCHI, Ji ...
    1998 Volume 22 Issue 2 Pages 173-176
    Published: June 25, 1998
    Released on J-STAGE: November 20, 2012
    JOURNAL FREE ACCESS
    Muscle fatigue of the deltoid and the biceps brachii muscles during arm flexion were detected electromygraphically to evaluate the role of each muscle as a flexor of the shoulder. This study was performed on 11 healthy men (21.1±2.2yrs. ). The anterior portion of the deltoid and both heads of the biceps were examined. The subjects performed the maximum strength (MVC) measurements at 45° of flexion and 30° of external rotation of the shoulder with the forearm neutrally rotated and the elbow extended. The peak torque was measured and electromyographic signals were recorded by surface electrodes simultaneously. Then 30% of the peak torque was applied to the upper arm until reaching the limit of patience. An integrated EMG was used to estimate the muscle activity. The maximum amplitude, the mean. power frequency and the turns count (threshold level>0.05mV) were used as estimates of the muscle fatigue. These data were detected at the time of the MVC, pre and post-fatigue. The mean power frequency decreased in all the muscles examined. The decreasing ratio of the deltoid was higher than those of the biceps muscles. The turns count decreased almost equally in all muscles. The IEMG and the amplitude increased in the biceps groups, especially in the long head. The deltoid muscle was harder to fatigue than the biceps muscles. The long head was remakably increased its activity with the fatigue phenomenon. This may be one of the causes of muscular disorders of the LHB.
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  • Tomomaro KAWAMATYA, Jun KUMAGAI, Shuji ISEFUKU, Katsum SATO, Koji ISHI ...
    1998 Volume 22 Issue 2 Pages 177-181
    Published: June 25, 1998
    Released on J-STAGE: November 20, 2012
    JOURNAL FREE ACCESS
    This paper is on the character of the torn rotator cuff especially patients in a younger age group. Biopsy speciments of the torn cuffs of 15 patients aged between from 20 and 40 were examined. There were 2 complete and 13 incomplete tears (3 articular sides,7 bursal sides and 3 intratendinous tears). Histological sections were investigated using H-E, Elastica-Masson stainings as well as immunostaining them with antibodies against the C-terminal of procollagen type I.
    Tears with a depth of more than one-half of the tendon thickness were observed i n 6 of the 13 incomplete tears. The disappearance of the wavy pattern of the tendon fibers were seen in all the specimens. Vessels were distributed within the tendon proper close to the torn stumps in complete tears, while they were found in the bursal side and were sparse in the articular side. Positive immunostaining was found. at the vessel walls and fibroblasts adjacent to them. They were also found at the margin of the torn stumps in the complete tears. In the incomplete tears, in contact, it was only found in the vicinity of vessels close to the bursal side.
    These findings suggest the healing potential of incomplete tears are limited compared with complete ones in patients of the younger age group.
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  • Katsumi TAKASE, Takahito HOTTA, Atsuhiro IMAKIIRE
    1998 Volume 22 Issue 2 Pages 183-187
    Published: June 25, 1998
    Released on J-STAGE: November 20, 2012
    JOURNAL FREE ACCESS
    [Purpose] We performed anterior acromioplasty on patients with shoulder impingement symptoms and examined how much demage to the rotator cuff influenced on the inferior acromial surface.
    [Methods] There were 28 patients (7 females and 21 males), including 6 patients without any rotator cuff demage,4 with partial thickness cuff tears and 18 with full thickness cuff tears. They were aged from 22 to 80 years (mean ; 58.2 years) at time of surgery.
    [Results] None of the patients were observed with a clear 4-layer structure. The patients without any cuff demage showed a partial disappearance of the synovial layer and fibrous tissue, and such degeneration tended to correlate with age. In patients with cuff tears, the degeneration was correlated with the severity and extent of the tears. Age rather than the presence and range of cuff tears influenced the changes of the coracoacromial ligament (C-A lig), in which the interstitial substance between the collagen fibers tended to decrease and these fibers tended to become coarser with aging.
    [Conclusion] Cuff tears caused pathological changes of the inferior acromial surface by mechanical loading, while it had almost no effect on the C-A ligament.
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  • Akira TAKAHASHI, Takeshi MORIOKA
    1998 Volume 22 Issue 2 Pages 189-192
    Published: June 25, 1998
    Released on J-STAGE: November 20, 2012
    JOURNAL FREE ACCESS
    Radiographs and MRIs of Ti and T2 weighted images in the coronal oblique and axial plane of the shoulders were performed on 26 patients (28 shoulders) with degenerative rotator cuff tears and several gradations of arthropathic changes.
    The average age of the patients at examination was 67 years (range,35 to 87).
    The arthropathic changes of the shoulder were classified into 5 groups by the x-ray findings as follows. Group A (3 shoulders)-superiorly migrated humeral head and narrowed joint space, B (5)-only superior migration, C (3)-only joint space narrowing, D (6)-subacromial spurs without superior migration, and E (11)-no changes. The presence, location and size of the cysts and the spurs in the humeral head of each group were evaluated, and the relationship between the cysts and the other arthropathic changes was investigated. The size of the cyst was judged as a large one with 15% or more of a maximum humeral head diameter and a small one with less.
    Cysts were observed in 10 shoulders (35.7%) and located in 4 positions of the anatomical neck: center, posterior, posteroinferior of the greater tubercle, and anteromedial of the lesser tubercle. Only one cyst in groups A and B with an elevated humeral head,2 anterior large cysts and many spurs in group C with severe arthropathic changes of the glenohumeral joint,7 cysts and a few spurs in group D and E were observed. In group E only two spurs were observed in two cases which had large cysts at the center of the greater tubercle.
    The formation of cysts was suspected to be early bone changes prior to the spurs and narrowing of the joint space. The location and enlargement of the cysts may be associated with the progression of arthropathic changes in the glenohumeral joint.
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  • Jun-ichi MAKI, Gen-itsu YOSHIKAWA, Masanori KIKKAWA, Sinsuke HUKUDA, R ...
    1998 Volume 22 Issue 2 Pages 193-197
    Published: June 25, 1998
    Released on J-STAGE: November 20, 2012
    JOURNAL FREE ACCESS
    A rare of cuff tear arthropathy associated with chondrocalcinosis is presented here. A 76-year-oldwoman with a 10-years-history of bilateral omalgia showed severe rotator cuff insufficiency on physical examination. Laboratory data did not indicate any inflammation. A plan radiograph of the left shoulder showed elevation and collapse of the humeral head. Other radiographs showed chondrocalcinoosis of the knee, the elbow and the write joint. Based on these findings, the authors diagnosed this case as cuff tear arthropathy, and hemiarthroplasty of the humerus was performed. Microscopic examination of the tendon atump of the subscapularis muscle revealed some calcium deposits closely approximating those of CPPD crystal on X-ray diffraction analysis. Cuff tear arthropathy was definds as a combination of a massive cuff tear, elevation and collapse of the humeral head, and damage to the glenohumeral joint. The hypothesis proposed by Neer concerning the pathomechanicism was that a massive cuff tear induces both nutritional and mechanical factors that provide a logical explanation for the development of a humeral head collapse. McCarty described a shoulder condition called the Milwaukee shopulder syndrome, which was nearly identical to cuff tear arthropathy, and emphasized that hydroxyapatite was strongly related to the pathogenesis of this shoulder condition. The authors suggest that the CPPD crystal also hastened the development of cuff tear arthropathy.
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  • Jun-ichiro HAMADA, Kazuya TAMAI
    1998 Volume 22 Issue 2 Pages 199-204
    Published: June 25, 1998
    Released on J-STAGE: November 20, 2012
    JOURNAL FREE ACCESS
    We wish to present 3 cases of bursal osteochondromatosis around the shoulder joint, two in the subacromial bursa and one in the subscapularis bursa.
    (Case 1) A 54-year-old-male complained of bilateral shoulder joint pain and visited our clinic on May 10,1996. Roentgenograms showed calcifications below the acromion and osteophytes at the undersurface of the acromion and on the greater tuberosity. Arthrography revealed a joint-side cuff tear in the right shoulder joint. We removed 6 loose bodies from the right subacromial bursa on January 13,1996.
    (Case 2) A 51-year-old-male suddenly developed pain and weakness of the left shoulder and visited our clinic on March 30,1996. Roentgenograms showed calcifications below the acromion and an osteophyte at the undersurface of the acromion. MRIs revealed a complete rotator cuff tear in the left shoulder. We removed 3 loose bodies from the subacromial bursa and 8 from the subcoracoid bursa on January 13,1997.
    (Case 3) A 29-year-old-male came to us in 1997 with right shoulder pain and instability. He had fallen down skiing in 1987 and had had a total of 30 subluxations of the right shoulder since. Roentgenograms showed calcifications below the coracoid process. We performed a Bankart's repair for the recurrent subluxation and removed 8 loose bodies from the subscapularis bursa on April 8. Light microscopy of the removed loose bodies revealed ring-like calcifications in Case 1 and lamellar bone and cartilage in Cases 2 and 3. No metaplastic chondrocytes were noted in the synovium. These results support our diagnosis of secondary osteochondromatosis in all 3 cases.
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  • Masashi KAMIHIRA, Tomomitsu KUTSUMA
    1998 Volume 22 Issue 2 Pages 205-208
    Published: June 25, 1998
    Released on J-STAGE: November 20, 2012
    JOURNAL FREE ACCESS
    We investigated the usefulness and problems of Ender nailing for surgical neck fracture of the humerus.
    We studied 16 patients who underwent Ender's nailing for surgical neck fracures of the humerus between 1988 and 1997. They consisted of 5 males and 11 females aged 20-93 years (average,65).
    According to Neer's classification, the fracture types were 2-part surgical neck fractures in 14 patients and 3-part fractures of the surgical neck and greater tuberosity in 2. The follow-up period ranged 6 to 120 months (average 43). We investigated the bony union, the range of motion of the elbow and shoulder joint and the postoperative JOA scores.
    All the patients obtained a bony un ion. The postoperative range of motion of shoulder joint was 132.8° in abduction and 43.4° in external rotation, and that of the elbow joint was -7.8° in extension and 135° in flexion. The postoperative JOA score of the shoulder was 85-100 points (average-91).
    In conclusion, Ender's nailing is a very useful operation for surgical neck fractures of the humerus.
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  • Nobuhiko KANAYA, Makoto TANAKA, Kenichi SHINOMIYA, Makoto HIRAISHI
    1998 Volume 22 Issue 2 Pages 209-212
    Published: June 25, 1998
    Released on J-STAGE: November 20, 2012
    JOURNAL FREE ACCESS
    We have been conducting internal fixations for a fracture of the mid-third clavicule. It is possible with this method to prevent a malunion and return to work early. We have used a cannulated screw because of its tight fixation and small incision. The type of screw initially used caused subcutaneus pain and there was a cancellous thread. Therefore we produced a second type of screw with a round tip and cortical thread. We wish to report on the good results we acquired with this devise.
    The subjects of this study were those cases which had contacted two fragm ents after a reduction. We applied this method on 25 patients (21 males and 4 females). Their ages ranged between 16 and 38years old. We developed the cannulated screw with Best Medical Co. Ltd. The initial type screw size had an outer diameter of 5.0mm thread, a shaft diameter of 4.0mm and the width of the thread was 1.75mm. The second type of screw had an outer diameter of 5.0mm thread, a shaft diameter of 4.0mm and the width of the thread was 1.0mm. We inserted a screw from the distal clavicula and obtained a tight fixation with the proximal cortical bone.
    The amount of bleeding was 50g on av erage. The operation time was 36 minutes on average. The length of the screw ranged from 80mm to 110mm. All the cases had a bone union. None of the cases had a limit of ROM, trouble of ADL or infection. But a screw was broken in one case.
    The advantages of an internal fixation using a cannulated screw are that it is a tight fixation, a small incision, an easy extraction and an easy operation. We believe that this method is useful for fracture of the mid-third clavicula.
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  • Fumiki MIZUE, Hiromoto ITO, Akinori TAKAYAMA, Katsuhiko IDE, Haruhisa ...
    1998 Volume 22 Issue 2 Pages 213-216
    Published: June 25, 1998
    Released on J-STAGE: November 20, 2012
    JOURNAL FREE ACCESS
    Purpose: The purpose of this study was to evaluate the clinical results of surgical treatment of a distal clavicle fracture using Wolter claviclar plates.
    Materials: Sixteen patients with distal clavicle fractures were treated between Febuary 1994 and January 1997. Their mean age at surgery was 39,1 years old. The mean follow-up period was 1 year and 7 months. The fracture types were classified into 10 cases of type II and 6 of type V using Craigs evaluation.
    Results: Active evevation of the affected shoulder joint acquired a mean value of 168°. All the patjents had neither postoperative pain nor muscle weakness. A good bony union was obtained in all the cases. The average JOA score was 95.1 points.
    Conclusion: Compared with tension band wiring, the Wolter clavicular plate was more advanced and better able to maintain the anatomical repositioning of an unstable distal clavicle fracture, however this method might cause more invasion at an operation or removal. Based on our study, a Wolter clavicular plate seems better suited than the usual method which does not have enough internal fixation because of the small fragments and unstableness.
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  • Keisuke OKAMURA, Jiro OZAKI
    1998 Volume 22 Issue 2 Pages 217-220
    Published: June 25, 1998
    Released on J-STAGE: November 20, 2012
    JOURNAL FREE ACCESS
    [Purpose] We studied the clinical symptoms and MR images of the shoulder with incomplete rotator cuff tears before and after surgery, and evaluated the effects of the surgical treatment.
    [Materials and methods] From 1993 to 1995, we studied 10 patients (7 males and 3 females) with incomplete rotator cuff tears of the shoulder who underwent MRI before and after surgery. The age of the patients was 44 to 70 years (mean,55 years) and the follow-up period was 3 to 13 months (mean,9months). Subacromial decompressions were carried out in all cases. Shavings of the rotator cuff were performed in 4 cases. Scanning was performed using a GE 1.5-T magnetic imaging system. Tiweighted and T2-weighted sequences were obtained in the oblique plane and in the axial plane.
    [Results] The clinical symptoms were markedly improved after surgery. The MR images of the shoulder with incomplete cuff tears were as follows: (preoperative/postoperative). An intratendinous high signal pattern: 80%/70%. An abnormal morphology of the tendon: 100%/30%. Subacromialsubdeltoid fluid 30%/30%. Loss of the subacromial-subdeltoid fat plane: 80%/90%. Fluid in the glenohumeral joint: 40%/0%. Fluid in the tendon sheath sheath of the biceps long head: 70%/30%.
    [Conclusion] A subacromial decompression was effective for the treatment of incomplete ro tator cuff tears, and MRI was useful for evaluation of the surgical treatment.
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  • Kie MIMORI, Takumi NAGAI, Masahiko KOMAI, Jun HASHIMOTO, Katsuya NOBUH ...
    1998 Volume 22 Issue 2 Pages 221-224
    Published: June 25, 1998
    Released on J-STAGE: November 20, 2012
    JOURNAL FREE ACCESS
    The purpose of this study was to re-examine a widely used classification of the rotator cuff tear based on our data. Since 1970,1048 shoulders (1037 patients) with rotator cuff tears have been operated on at Nobuhara Hospital.
    The subjects we re 625 males and 150 females, aged from 17 to 87 years (mean 56). Obtaining surgical findings such as the shapes and involved torn tendons, the materials were analyzed comprehensively. The forms of the rotartor cuff tear were classified into 9 types. A massive tear was the most prolific,206 cases (27%). The ratio of the torn tendon was as follows: the supraspinatus tendon (SSP) 97%, the infraspinatus tendon (ISP) 65%, the teres minor tendon 13%, and the subscapularis tendon 28%.8groups were set up by combining each tendon, the correlation of both was investigated. Except for ISP tears and anterior tears, the SSP was in all rotator cuff tears. The extent of the retraction of a tendon end tended to be over estimated even in cases of one or two tendons. A subsidence with a degeneration in a concealed tear seemed to result from the retraction of the torn deep layer of an SSP and ISP. Our results revealed a 7.5% misjudgement on deciding which form of rotator cuff tear. Our findings on rotator cuff tears were diagnosed and judged subjectively by the surgenos. The pathologic states of the rotator cuff should be expressed more accurately, augmenting our findings on the form and shape of the involved tendons.
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  • Isao SAITO, Hiroshi MINAGAWA, Tomio NISHI, Masashi OBA, Eiji ITOI
    1998 Volume 22 Issue 2 Pages 225-228
    Published: June 25, 1998
    Released on J-STAGE: November 20, 2012
    JOURNAL FREE ACCESS
    The purpose of this study was to clarify the isometric strength of ashoulderabduction and external rotation in small tears of the rotator cuff.
    Among 18 symptomatic shoulders w ith small tears of the rotator cuff (area<4cm2on MRI ),11Shoulders (11 patients ) without a history of shoulder pain on the contralateral side were enrolled in this study. The patients were groupedaccording to the location of the tear; six had the isolated supraspinatus (SSP ) tears (mean age 61 years, mean size 1.31cd) and six had the SSP-infrspinatus (ISP ) tears (mean age 65 years, mean size 1.52cm2). We measured the isometric strength of abduction and external rotation of both shoulders using a Micro FET II (Nihon medics). A preliminary session was followed by three maximum efforts after injectina 5? of 1 % mepivacaine into the subacromial bursa ofthe tear side to relieve pain. The peak torque which was the highest torque value seen from all repetitions were measured and expressed percentages of thoseof the contralateral side.
    The external rotation strength of the isolated SSP tears was almost equal tothe SSP-ISP tears (100.3±11.0%,107.8 ±12.6%, respectivly ). On the other hand, the abduction strength of the isolated SSP tears was significantly smaller than the SSP-ISP tears (65.0±30.3%129.3 ±26.4%, respectively; p=0.042). The abduction strength in small teats was affected by the location of the tear.
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  • Yoshio IWATA, Masao KUROKAWA
    1998 Volume 22 Issue 2 Pages 229-231
    Published: June 25, 1998
    Released on J-STAGE: November 20, 2012
    JOURNAL FREE ACCESS
    Adjustment of a shoulder brace can be difficult, especially in internal and external rotations. In 1986, we developed the design of the shoulder brace, Mark 1, which could maintain the shoulder in the zeroposition, and have used this device in a rehabilitation after a rotator cuff repair. The Mark 1 differs from other braces with regard to two points. One is that the center of abduction is placed in front of the shoulder and the other is that the adjustor rotates the upper arm. However, there are still three problems with the Mark 1 brace; 1. An individual fitting and manufacture required.2. heavy.3. difficult to adjust the appropriate position of the shoulder. So, we designed a new shoulder brace, the Mark 2 which is adjustable, ready-made and lighter.
    The Mark 2 shoulder brace can be adj usted easily from 30° to 150° at 10 degree units: Adduction and abduction limits can be set up in relation to each other, so the Mark 2 allows for a more flexible ROM. The axis of internal and external rotation can be put along the humerus with two parallel bars to the humerus. Compared with the Mark 1, the Mark 2 fits more comfortably and easily. However, the Mark 2 can not be lighter and be a ready-made product.
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  • Takeshi SAKATA, Jun HASHIMOTO, Taizan SHIRAKAWA, Satoshi MURAT, Katsuy ...
    1998 Volume 22 Issue 2 Pages 233-237
    Published: June 25, 1998
    Released on J-STAGE: November 20, 2012
    JOURNAL FREE ACCESS
    The purpose of this study was to compare the clinical features of the subscapularis tendon avulsed from the lesser tuberosity with those of the subscapularis tendon torn from the rotator interval to the bicipital groove.
    Sixty-two shoulders in 62 patients were diagnosed with isolated rupture of the subscapularis tendon (SSC) or rupture of the SSC with the anterior part of the suprasupinatus tendon at Nobuhara Hospital. We divided the pattern of the rupture of the SSC into two groups. Group A (N=26): the SSC avulsed from the lesser tuberosity. Group B (N=36): the SSC was torn from the rotator interval to the bicipital groove. The causes of the injuries, the arthrographical findings and the relationships between ruptures of the SSC and the long head of the biceps tendon (LHB) were examined in both groups. The clinical results were evaluated in 22 patients, who were assessed directly at a mean follow-up time of 83 months.
    In group A, trauma caused the injuries in 92% shoulders. In group B, trauma caused them in 89%shoulders. An arthrography detected the SSC ruptures in group A (88%) more frequently than in group B (38%). Eight of 9 shoulders with a subluxation or dislocation of the LHB belonged to group A (p>0.01). The clinical results by 6 months had improved except for the external internal rotations in range of motion, and they were maintained until the final follow-up. The results of this study indicate that the SSC avulsed from the lesser tuberosity had a more frequent subluxation or dislocation of the LHB than SSC from the rotator interval to the bicipital groove.
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  • Naoki SUENAGA, Akio MINAMI
    1998 Volume 22 Issue 2 Pages 239-243
    Published: June 25, 1998
    Released on J-STAGE: November 20, 2012
    JOURNAL FREE ACCESS
    We wish to report the results whose present ten shoulders of nine patients: seven were men and two were women, whose average age was 59.3 years (range 28 to 79 years); with subcoracoid impingement syndrome who had undergone a coracoplasty.
    The average follow-up was 12.6 months. All the patients had anterior shoulder pain, a positive horizontal adduction test and positive subcoracoid block. Eight patients had undergone surgical procedures, including an anterior acromioplasty in seven patients and osteosynthesis of the coracoid process in one. Coracoplasty was performed after a deltopectoral approach without a complete dissection of the conjoined tendon.
    The horizontal adduction test was negative in all the shoulders after the surgery. Eight shoulders had a complete resolution of preoperative symptoms and two shoulders had mild residual discomfort. One of the two shoulders needed a reoperation due to subacromial impingement syndrome.
    We concluded that coracoplasty for subcoracoid impingement syndrome is a useful procedure.
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  • Hidetaka MIKI, Shigeyuki WAKITANI, Masataka NISHIKAWA, Norikazu MURATA ...
    1998 Volume 22 Issue 2 Pages 245-247
    Published: June 25, 1998
    Released on J-STAGE: November 20, 2012
    JOURNAL FREE ACCESS
    [Purpose] We previously reported that patterns of shoulder joint destruction in rheumatoid arthritis (RA) could be classified into 5 groups: non-progressive (N) with normal radiographs, erosive (E)showing marginal erosion, but no collapse, collapse (C) showing a subchondral cyst,, followed by collapse, arthrosis-like (A) showing osteoarthritic features, and mutilating (M) showing mutilating bone destruction. In this study, we analyzed the results of RA shoulder surgery for each group with a different destruction pattern.
    [Materials and Methods] 43 RA patients (53 shoulders) who under went shoulder surgery were studied.43 patients consisted of 5 males and 38 females, and this mean age was 51 (28-76) years. The mean duration of the disease was 12 (3-36) years.
    21 synovectomies (6 N types,11 E t ypes, and 4 C types) and 32 prosthetic replacements (9 E types,14 C types, and 9 M types) were studied.
    [Results] Synovectomy was effective for N type of shoulder joint destruction. It was also effective for E types in the early disease course. Prosthetic replacement was effective for E type in the late disease course. Synovectomy was not effective for C type, but prosthetic replacement was. A prosthetic replacement was effective only for reducing pain for M type.
    [Conclusion] Our classification of RA shoulder joint destruction was useful in selecting the treatment, including surgery.
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  • Teruhiko NAKAGAWA, Masamitsu TSUCHIYA, Takayuki SUGIHARA, Makoto TANAK ...
    1998 Volume 22 Issue 2 Pages 249-254
    Published: June 25, 1998
    Released on J-STAGE: November 20, 2012
    JOURNAL FREE ACCESS
    We have performed a posterior glenoplasty using an iliac tri-cortical bone graft for recurrent posterior dislocation of the shoulder since 1993. The purpose of this paper is to report on our surgical procedure and the results.
    We reviewed 1 1 shoulders of 10 patients ( 7 males,3 females,4 right,5 left,1 bilateral). All the patients had had snapping and pain with a positional reduction or dislocation. The average age at the operation was 18.7 years (range: 15-26 ), and the average follow-up period was 25 months (range,12-45months). The surgical procedure was as follows: a 7 cm longitudinal incision was made. The deltoid and the infraspinatus were split and the capsule was opened transversely. The cortex of the glenoid neck was exposed. The bone graft from the iliac crest (tri-cortical bone, length: 20mm, height: 15mm)was placed into the glenoid neck at the level with the articular surface, and secured by two compression screws. A posterior capsulorraphy was performed. The shoulders were immobilized with the arm in 20° abduction and slight external rotation. The screws were removed more than 6 months after the operation. Ten shoulders had no recurrence. One shoulder had a recurrence of posterior instability with a mild snapping (recurrence rate 9 % ) but in this case, the pain had vanished. Ten shoulders(91%)were pain-free. One shoulder had moderate pain and crepitus with shoulder motion. All eleven shoulders attained an almost full range of motion (average ROM: elevation 168 ° external rotation 88° , internal rotation Th 7-8). The grafted bone united with the glenoid neck 3-4 months after the operations. Resorption of the grafts occurred in all the shoulders and the length of the protruded portion posteriorly which had been about 15mm became 5-11mm (average 7.8 mm). Osteoarthrotic changes were not recognized in any of the eleven shoulders.
    We recommend the posterior g lenoplasty using an iliac tri-cortical bone graft, because of its technical ease and good results.
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  • Hiroshi YAMADA, Katsuhiko KITAOKA, Eiji SHIMOZAKI
    1998 Volume 22 Issue 2 Pages 255-258
    Published: June 25, 1998
    Released on J-STAGE: November 20, 2012
    JOURNAL FREE ACCESS
    [Introduction] Soft tissue operations for anterior instability have a high rate of failure in a patient with recurrent anterior shoulder dislocation and epilepsy, because of the extensive bone defects of the glenoid and posterolateral notch of the humerus. We wish to report our experience of a case of recurrent anterior bilateral shoulder dislocation treated with a bone buttress operation and corrective rotational osteotomy of the proximal humerus.
    [Patient and methods] A 28-year-old-woman had been treated for epilepsy since she was 15 years old, but control was poor. The first bilateral shoulder dislocation with epilepsy occured when she was 15years of age, and the episode recurred. She underwent two stabilizing procedures on her right shoulder and one on her left shoulder in another hospital, but the results were unsuccessful. The radiographs showed extensive bone befects of the glenoid, the posterolateral notch of the humerus and rhe anteversion of the humeral head. After the epilepsy was controled, we performed a bone buttress operation and corrective rotational osteotomy of the proximal humerus on her left shoulder.5 months later, we performed the same procedure on her right side. After the operation the arm was immobilized for four weeks, after which it mobilized.
    [Results] She had no dislocations at the follow-ups 14 months after her left shoulder operation or 11months after the right shoulder. The flexion was 160°, abduction was 160°, external rotation was 80. and internal rotation was 90° after the operations. Although she had a slight pain in her left shoulder, she had no problems in her daily life.
    [Conclusion] We think a bone buttress operation and corrective rotational osteotomy are effective procedure for the recurrent shoulder dislocation and epilepsy.
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  • Shinjirou KOBAYASHI, Kazutoshi HAMADA, Tomotaka NAKAJIMA, Nari YAMADA, ...
    1998 Volume 22 Issue 2 Pages 259-262
    Published: June 25, 1998
    Released on J-STAGE: November 20, 2012
    JOURNAL FREE ACCESS
    Inferior and multidirectional instability of bilateral shoulders developing in a patient with autosomal recessive distal muscular dystrophy (ARDMD) was reconstructed surgically, which has not been reported yet.
    (A Case Report) A 41-year-old-man was diagnosed as having ARDMD at age 27. He started to use a wheel-chair at age 30 which bore weight on bilateral his shoulders, which gradually made them unstable. Finally, at age 36, inferior subluxation of the left shoulder occurred frequently during his daily living activies.
    (Course) At the initial examination, bilateral shoulders shoulders showed inferior subluxation at reat, which was reduced by shrugging. Inferior and anterior instabilities were recognized, which resulted in positive inferior and anterior apprehension signs. Preoperatively, the JOA scores of the left and right shoulders were 26.0 and 35.5 point out of 100, respectively. At age 38, an inferior capsular shift and glenoid osteotomy were performed on his left shoulder, and 1.5 years later, on his right. Both of the operated shoulder were immobilized in a spica for 6 weeks and obtained 71 points at 3.5-year-and 2year-follow-ups. The purpose of this surgical reconstruction was to get three-dimensional tightness of the joint capsule and prevent inferior translation of the humeral head due to muscle dystrophy. He has never complained of pain in ADL or recurrence of shoulder instability. (Conclusion) Inferior capsular shift accompanied by glenoi d osteotomy could prevent inferior and multidirectional instability effectively in a patient suffering from incurable muscle weakness.
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  • Hiroshi NOGUCHI, Minoru YONEDA, Keiko KAGAYA, Atushi HIROOKA, Hiroshi ...
    1998 Volume 22 Issue 2 Pages 263-266
    Published: June 25, 1998
    Released on J-STAGE: November 20, 2012
    JOURNAL FREE ACCESS
    The treatment of initial traumatic anterior dislocation of the shoulder has not been established. We, orthopaedists, are eager to know whether it is possible to predict the prognosis of an initial dislocated shoulder or not. The purpose of this study was to clarify the characteristic findings of MR arthrography (MRA) and intraarticular lesions indicating instability in a first-time dislocated shoulder.
    Ten patients (9 males and 1 female) who sustained initial traumatic anterior dislocations of the shoulder underwent arthroscopy. The average age was 25.8 years old (range: 20 to 39 years). We investigated the correlation the between the results of the examination under anesthesia (EUA) and MRA findings and intraarticular lesions by arthroscopy. The MRA findings were classified using the Hirose's system and the intraarticular lasions were classified using Baker's arthroscopic criteria.
    Two shoulders were stable on EUA. They had negative Bankart lesions using Hirose's MRA classification. Their anthroscopic findings were no labral lesion and a partial labral lesion, which corresponded with Baker's group I and group II. The other 8 shoulders had unstable EUA. They had positive Bankart lesions under Hirose's MRA classification. In 7 of the 8, labral disruptions and detachment of the IGHLs appeared under arthroscopy, and these findings corresponded with Baker's group III.
    Thus, we found that preoperative MRA findings by Hirose's classification and arthroscopic findings based on Baker's criteria were essential factors to predict the fate of an initial dislocated shoulder.
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  • Yutaka MORISAWA, Masataka NOGUCHI, Teruhiko KAWAKAMI, Hiroshi YAMAMOTO ...
    1998 Volume 22 Issue 2 Pages 267-269
    Published: June 25, 1998
    Released on J-STAGE: November 20, 2012
    JOURNAL FREE ACCESS
    We studied the mechanism of musculocutaneous neuropathy associated with the Boytchev procedure in cadavers.
    (Materials and methods)
    The subjects we re 21 adult cadavers (42 shoulders) for anatomical study. The distance from the anterior end of the coracoid process to the site of the entry of the musculocutaneous nerve trunk into the coracobrachialis muscle was determined as A, the distance to the insertion of the short head of the biceps among the nerve branches as B, and the distance to the coracobrachialis insertion site as C. Then, the coracoid process (served to measure the insertion of the short head of the biceps and that of the coracobrachialis) was returned to its original position beneath the full-thickness of the subscapularis muscle by the original Boytchev method, and the distance from the anterior end of the coracoid process to the lower margin of the subscapularis was determined as D.
    (Results)
    A was 47.5±13.2mm, B was 30.1±6.2mm, C was 33.9±7.5mm and D was 33.3±5.3mm. A was below D, i. e., the entry site of the musculocutaneous nerve trunk was above the lower margin of the subscapularis muscle, and entrapment of the musculocutaneous nerve trunk by the subscapularis muscle was present in nine shoulders (21.4%).
    (Discussion)
    In patients where the site of the entry of the musculocutaneous nerve trunk into the coracobrachialis muscle is at a higer position than the lower margin of the subscapularis, it appears necessary to take technical precautions such as passing the severed coracoid process through the lower one third of the belly of the subscapularis.
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  • Masakazu URAYAMA, Eiji ITOI, Norikazu KONNO, Tadato KIDO, Akihisa SANO ...
    1998 Volume 22 Issue 2 Pages 271-273
    Published: June 25, 1998
    Released on J-STAGE: November 20, 2012
    JOURNAL FREE ACCESS
    Introduction: In recurrent anterior dislocation of the shoulder, the enlarged capsule is often noticed on arthrography or during surgery. The purpose of this study was to quantify the elongation of the capsule in recurrent anterior dislocation of the shoulder using MR arthrography.
    Materials and Methods: There were 16 shoulders with recurrent anterior dislocation (instability group, average age 23 years) and 7 shouders of normal volunteers (control group, average age 20 years). MR images were obtained after 10ml of gadolinium/saline solution (1: 100) was injected into the glenohumeral joint under fluoroscopic guidacce. The slice at the level lcm superior to the inferior margin of the glenoid in axial plane was scanned into a computer, and the length of the anterior and posterior capsule was measured using NIH Image software. The length was normalized to the humeral head diameter.
    Results: The anterior capsule was significantly longer in the instability group (43.7±7.9 mm) than in the control group. (37.0±4.3 mm; p=0.045). The posterior capsular length did not show any significant difference between the groups. Conclusion: The anterior capsule was elongated in recurrent anterior dislocation of the shoulder.
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  • Michimasa UI, Kiyohisa OGAWA, Wataru INOKUCHI, Toyohisa NANIWA
    1998 Volume 22 Issue 2 Pages 275-278
    Published: June 25, 1998
    Released on J-STAGE: November 20, 2012
    JOURNAL FREE ACCESS
    [purpos] The purpose of this study was to evaluate the relationships between the clinical manifestations of an anterior glenohumeral instability and the qualitative factors of a first dislocation.
    [Materials and Methods] We retrospectively reviewed 210 patients (210 shoulders,178 males,32 females). The patterns of glenohumeral anterior instability were divided into 10 groups by combination of the dislocation, subluxation and dead arm syndrome. These 10 patterns were compared with the causes of the first dislocation, participation in sports, and the period of fixation using a sling after reposition.
    [Results] Participation in sports was a high (83-88%) cause for a first dislocation, but there were no statistical differences between the 10 patterns. The force to the abducto-external position was highly concerned in the injury mechanism, but again there were no statistical differences between the 10 patterns.
    [Conclusion] There were no statistically significant differences between the patterns of glenohumeral anterior instability and the causes of the first dislocation, participation in sports, and the period of the immobilization.
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  • Tomohisa HASHIUCHI, Jiro OZAKI, Hideaki TATSUMI, Tokuji KASHIRO
    1998 Volume 22 Issue 2 Pages 279-281
    Published: June 25, 1998
    Released on J-STAGE: November 20, 2012
    JOURNAL FREE ACCESS
    [Purpose] The purpose of this study was to evaluate the MRIs of modified Bristow procedure and Putti-Platt procedure for recurrent anterior dislocation of the shoulder.
    [Materials and Methods] Between January 1992 and May 1997,7 shoulders of 7 patients, received a Modified Bristow procedure or Putti-Platt procedure were evaluated using MRIs. Five cases (5 men)with an average age of 22 years (range,20-26) who had been diagnosed as having recurrent anterior dislocation of the shoulder underwent modified Bristow procedures. Two cases (1 man and 1 woman)with an average age of 23.5 years (range,22-25) underwent Putti-Platt procedure. Several images in the transverse and oblique planes-that is, perpendicular to the glenoid surface, were obtained. Then changes of signal intensity were examined in both procedures.
    [Results] After a Putti-Platt procedure the subscapularis tendons were thickened and decreased signal areas on T2 weighted images were observed in all. After a modified Bristow procedure the subscaplaris muscle fibers were compressed and increased signal lesions on T2 weighted images were observed around the long head of the biceps tendon.
    [Conclusion] Putti-Platt procedure suggested that the strength of the subscapularis tendon had increased. In the Modified Bristow procedure subscapularis and the long head of the biceps ware considered to have the several anatomical consequences.
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  • Mitsuko YAMADA, Minoru YONEDA, Takafumi YAMAMOTO
    1998 Volume 22 Issue 2 Pages 283-286
    Published: June 25, 1998
    Released on J-STAGE: November 20, 2012
    JOURNAL FREE ACCESS
    [Purpose] The purpose of this study was to find out if a Micro FET is a useful device for detecting the shoulder functions of patients with a rotator cuff tear. We examined the relationships between the area of the rupture of the rotator cuff, the pre-and post operative functions and the muscle power of the shoulder joint.
    [Materials and Methods] We investigated 18 patients who could be observed for more than a year after their operations. There were 17 males and 1 female, whose average age was 60.7 years.
    After arthoroscopic subacromial decompression, arthoroscopic repair of the rotator cuff was performed on 6 patients, performed in 6 patients, an open repair on 10 patients, and Teflon patching on 2 patients.
    The average length of follow-up was 12.9 months.
    The muscle strength was measured by usin g a Micro FET in the following positions:
    (1)with shoulder joint abduction at 90° in the scapular (90° abduction),
    (2)45° abduction with the thumb down (45° abduction), and (3)external rotation with the arm hanging at the side.
    We also evaluated the unaffected sides then we ratioe d the affected sides to the unaffected sides.
    The area of the cuff tear was measured at operation time.
    [Results] Before the operations there were no significant correlation between the area of the cuff tear and the preoperative Micro FET values and the JOA score. But the Micro FET values (90° abduction,45° abduction) significantly correlated with the total JOA scores and the functional parameters. Postoperatively, the Micro FET values correlated with the total JOA scores and the functional parameters significantly.
    [Conculusion] Micro FET values obtained at 90° abduction are useful to evaluate shoulder function pre and postoperatively.
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  • Hiroshi MINAGAWA, Tomio NISHI, Masashi OBA, Eiji ITOI
    1998 Volume 22 Issue 2 Pages 287-291
    Published: June 25, 1998
    Released on J-STAGE: November 20, 2012
    JOURNAL FREE ACCESS
    The supraspinatus (SSP ) tendon attaches to the superior facet and the superior half of the middle facet, whereas the infraspinatus ( ISP) tendon attaches to the entire middle facet, making an overlap between these tendons. Therefore, it seems possible to identify the tendons involved in a tear judging from the facets. The purpose of this study was to assess torn tendons in small tears of the rotator cuff on MRIs. Among forty-two symptomatic shoulders of 40 consecutive patients with a rotator cuff tear on MRI,18 shoulders with small tears (area<4cm2) were enrolled in this study. T2 weighted images in sagittal oblique and coronal oblique planes were obtained using a 0.5-T MR imager (Toshiba FLEXART ) The patients were divided into two groups: high signal intensity on the superior facet only (Group 1 ) and high signal area extending to the middle facet (Group 2 ). Group 1 corresponds to the isolatedSSP tears and Group 2 corresponds to the SSP-ISP tears. The statistical significance between the tear size in Group 1 and Group 2 was assessed using the Student t test. Eight shoulders were isolated SSP tears (Group 1 ), and 10 shoulders were SSP-ISP tears (Group 2 ). The size of the isolated SSP tears and the SSP-ISP tears were 1,55 ±0.72cm2and 1.52 ±0.96cm2, respectively. There was no significant difference between the tear size in either group. Small tears of the rotator cuff involved ISP tendon rupture in more than 50 %.
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  • Kazushige HASEGAWA, Shiro TABATA, Toshitake AIZAWA
    1998 Volume 22 Issue 2 Pages 293-296
    Published: June 25, 1998
    Released on J-STAGE: November 20, 2012
    JOURNAL FREE ACCESS
    [Purpose] We wished to examine the correlation between residual complaints of operated rotator cuff tears and the size of the tear.
    [Materials and Methods] 77 patients who had been operated on between 1985 and 1993 were available for this follow-up study. The patients were assigned to two groups, large or small, based on the size of their tear. Using the JOA scores, the following points were examined: 1)complaints of ADL,2)pain,3)limitation of ROM,4)muscle weakness of abduction,5)limitation of external rotation,6)muscle weakness of external rotation. The two groups were compared from each point, and the relationship between the severity and the size of the tears were examined.19 cases, who had had residual complaints, were also analyzed for correlation between the size of the tear and the following points: )sleep on the involved side,2)reaching an overhead shelf,3)combing their hair.
    [Results] 17 cases had a large tear and 60 cases had a small one. ADL and pain were insignificant in both two groups. There was a significant difference between their ROM and muscle weakness (Mann-Whitney test). The size of the tear correlated to pain and muscle weakness, but not to complaints of ADL. In pa. tients with residual complaints, size of the tear correlated with difficulty in reaching an overhead shelf (Chi-square test).
    [Conclusion] In this study, we did not find a direct statistical correlation between daily life complaints and the size of a tear. Previously, we reported on a correlation of residual complaints to pain and muscle weakness in external rotation. Since both residual complaints and the size of the tear correlated to pain and muscle weakness, these studies suggest that patients with large tears tend to have residual complaints about them.
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  • Cuff Tendon Failure
    Munekazu DOI, Tokihito FUKUYAMA, Yukinobu KANOH, Chisato WATANABE, Ats ...
    1998 Volume 22 Issue 2 Pages 297-299
    Published: June 25, 1998
    Released on J-STAGE: November 20, 2012
    JOURNAL FREE ACCESS
    [Purpose] This study investigated the suitable trunk positions to relax the muscles of patients with rotator cuff tendon failure during postoperative exercises.
    [Patients and Methods] Ten patients with s u rgically treated tear or tendinitis of the rotator cuff were postoperatively evaluated by electromyography. The mean patient age was 51 years. Surface electrodes recorded the activity in the trapezius, the deltoid (anterior, middle, posterior), the pectoralis major, the latissimus dorsi, the biceps, the triceps and the infraspinatus while their arms were passively elevated as much as possible after patients were instructed to relax their muscles. The values of integrated EMGs for each muscle were recorded in the sitting, lateral and supine positions and then compared.
    [Results] In the sitting position, the activities in the trapezius and deltoid were high. In the lateral position, the avtivity in the trapezius and middle deltoid decreased but activity in the posterior deltoid and triceps increased in some cases. In the supine position, values of intergrated EGMs for all the muscles decreased compared with those in the sitting position.
    [Conclusion] For postoperative exercises for pa tients with rotator cuff tendon failure, relaxation of the muscle around the shoulder can be achieved in the supine position.
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  • Masao ETO, Nobuyuki ITO, Tadashi TOMONAGA, Hirofumi INOUE
    1998 Volume 22 Issue 2 Pages 301-305
    Published: June 25, 1998
    Released on J-STAGE: November 20, 2012
    JOURNAL FREE ACCESS
    We have treated the patients with rotator cuff tear by McLaughlin' s procedure along with a partial lateral acromionectomy and resection of the coraco-acromial ligament. The purpose of this study is to investigate the influecing factors on the postoperative results of rotator cuff tear treated by this method.
    122 shoulders were followed up for 6 months to 12 years (average 47 months). There were 10 5 males and 13 females with an average age of 54 years. McLaughlin's procedure was performed in 118 shoulders and patch graft procedures were done in rest 4 patients. We evaluated the pre and post-operative results according to the shoulder evaluation sheet of the Japanese Orthopaedic Asociation (JOA score). In all the patients size of the tear, age at operation, time between the onset and operation, preoperative JOA score ane presence of shoulder contracture before operation were investigated. There were partial or small tear in 25 shoulders,55 medium tears and rest 42 shoulders had large tears.
    The average postoperative JOA score for partial or small tear, medium and la rge tears were 92.5,92.1 and 88.0 points respectively. There were statistically significant differrences between the large tear with the rest 2 types. Postoperative JOA score showed no correlation with the age at operation, preoperative JOA score, time betwen the onset and operation, follow-up period and presence of shoulder contracture before operation.6 patients had poor results with postoperative JOA score lower than 80points.5 of them had large tears and rest one had small tear.4 out of these 5 large tear cases showed rerupture of the rotator cuff by MRI or arthrographic examination. Therefore, in large tears due to degenerative changes and the large gap, forceful pulling of the rotator cuff during operation may cause rerupture. Postoperatively 3 cases with large tear and 2 cases of medium tear had transient brachial plexus palsy. The cause of this transient brachial palsy was thought to be due to horizontal abduction position of the arm or compression of the plexas by the casting material. Therefore, to avoid this complication, care must be taken while casting the patient in zero position postoperatively.
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  • Junko YAMAGUCHI, Masao KUROKAWA, Motoyuki HORII, Kunihiko YANAGA, Taku ...
    1998 Volume 22 Issue 2 Pages 307-310
    Published: June 25, 1998
    Released on J-STAGE: November 20, 2012
    JOURNAL FREE ACCESS
    The clinical results of surgical treatment using McLaughlin's technique for rotator cuff tears were investigated and the two groups with and without our newly designed shoulder brace were compared. Seventy-three cases (seventy-seven shoulders) underwent surgery by McLaughlin's technique. The subjects consisted of 56 males and 17 females aged from 18 to 74 years (average 53.8). The group with a brace consisted of 44 shoulders and their average age was 56.4 years. The tear sizes varied from small to massive. The group without the brace consisted of 33 shoulders and their average age was 50.4years. The tear sizes were partial, small, medium or large. The cases with small or medium size tears, with or without the brace were 32 shoulders and 21 shoulders, respectively. The clinical results were evaluated by the Japanese Orthopedic Association (JOA) score for the shoulder and ROM. The JOA scores of the groups with and without the brace improved from 64.9±21.6 to 85.0±17.0 points and from 67.2±23.8 to 89.7±12.1, respectively. The pre- and postoperative ROM of the group with the brace were flexion 136.7±33.4° and 139.2±12.8°, and external rotation 50.0±12.5° and 41.4±11.8°. Those of the group without the brace were flexion 123.8±28.1° and 153.5±8.5° and external rotation 41.3±19.6°and 41.5±14.3°. Postoperative complications occurred in 4 shoulders of rerupture in the group with the brace and 1 shoulder of infection in the group without the brace. The pre- and postoperative JOA scores and ROM of the cases with small and med i um size tears in both groups were not significantly different.
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  • Toshitaka AIZAWA, Shiro TABATA, Kazushige HASEGAWA
    1998 Volume 22 Issue 2 Pages 311-314
    Published: June 25, 1998
    Released on J-STAGE: November 20, 2012
    JOURNAL FREE ACCESS
    [Purpose] To analyze the factors correlating to a reoperation after a cuff repair, we examined the patients' backgrounds and their operative findings of the first and second operations and the operative procedures.
    [Materials and methods] Rotator cuff repairs on 562 shoulders were done from 1976 to 1997 in our hospital, and 26 shoulders in 25 patients were reoperated because of poor results. Tears were classified according to the size, large, which involved two tendons, small, which involved one tendon, and the remainder incomplete. Those shoulders without any reoperation were used as the control. The re operation rate was investigated in each group.
    [Results] There were 23 males a nd three females in the reoperated group, the rate of the male was significantly higher then that of the control group. Five shoulders had a large tear,9 shoulders had a small one, and 12 had a incomplete one. The reoperation rate of large tears was 5.2% (12/117), that of small tears was 2.6% (9/348), and that of incomplete tears was 10.2% (5/97). The reoperation rate after a McLaughlin proceure was 5.8% (17/274), and the rate after a Debeyre procedure was 18.6%(3/13). Four shoulders (80%) with a large cuff tear were reoperated within 6 months after the first operations. Another cuff tear was often found in the incomplete tear group at the second operation.
    [Conculosion] The reoperation rate of shoulders with an incomplete tear was significa ntly higher than those of the other two groups.
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  • Satoshi MURAI, Taizan SHIRAKAWA, Jun HASHIMOTO, Yoshiaki KANATANI, Kat ...
    1998 Volume 22 Issue 2 Pages 315-318
    Published: June 25, 1998
    Released on J-STAGE: November 20, 2012
    JOURNAL FREE ACCESS
    The purpose of this study was to evaluate the effect of using the Zero Position cast for post operative treatment altar a rotator cuff repair.
    120 shoulders with a rotator c uff tear were investigated. Postoperatively, skin traction with the upper limb in Zero Position was applied for 4 or 5 days. Then, the body spica cast was applied in the same position for 2 or 3 weeks. From the early phase of immobilization the elbow and shoulder exercises were performed in the bivalved cast. The ranges of motion and muscle strengths were measured before surgery and 2 months after surgery.
    The R0M in flexion and ab duction recovered satisfactory. The flexion angle was 130.0° before and 141.4° after surgery, and the abduction angle was 110.5° before and 128.0° after surgery. The rotational angle changed from 51.5° before surgery to 44.8° after surgery in ER, and from 53.8° to 53.4° i n I R. Twelve patients (10%) had an abduction contracture and half of them were diagnosed as an incomplete cuff tear. The muscle strength improved in all motions. The period of immobilization averaged 16.7 days. In the results, there was no difference between the under-l4-day group and the over15-day group concerning the duration of the immobilization.
    The Zero Position should be the most suitab le position theoretically for a cuff repair. According to our results, even two months after surgery, the R 0 M and muscle strength had recovered almost satisfactory. Patients with an incomplete cuff tear require early exercise. We conclude that the Zero Position cast is effective as the postoperative treatment of a cuff repair.
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  • Toru KOMURO, Minoru YONEDA, Hiroshi SEKI, Keiko KAGAYA, Hiroshi Noguch ...
    1998 Volume 22 Issue 2 Pages 319-322
    Published: June 25, 1998
    Released on J-STAGE: November 20, 2012
    JOURNAL FREE ACCESS
    The purpose of this study was to determine the influential factors on muscle strength improvement of postoperative patients following repair of rotator cuff tears. Twenty patients with full-thickness rotator cuff tears who underwent operative repair were included in this study. The isometric muscle strength, measured by hand-held dinamometer (Micro-FET), were reached 78 per cent of the uninvolved in abduction, and 87 per cent of the uninvolved in external rotation at one year postoperatively. Muscle strengths of abduction and external rotations related significantly to the preoperative range of motion under anesthesia. These results indicated that extending the range of motion as much as possible before an operation was best for improvement of muscle strength of shoulders underwent to repair of a rotator cuff tear.
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  • Hiroaki TSUTSUI, Kenichi MIHARA, Shigeru HOKARI, Kazuhide SUZUKI, Haji ...
    1998 Volume 22 Issue 2 Pages 323-326
    Published: June 25, 1998
    Released on J-STAGE: November 20, 2012
    JOURNAL FREE ACCESS
    We have had excellent clinical results for cases with shoulder disorders using the concept of the Cuff-Y exercise. The purpose of this study was to clarify the selection of physiotherapy from the improvement results.602 cases who complained of shoulder pain were estimated. The degree of pain, X-ray examinations of the Scapula-45, EMG studies of the supraspinatus, the deltoid, the biceps brachii and the infraspinatus. And the range of motion were examined.405 cases with decreased pain demonstrated improvement of the cuff index and the scapula index from the Scapula-45 X-ray films. They were divided into two groups.387 cases had improved function of the rotator cuff, and the other 18 cases showed compensative muscle activity.197 cases showed no remarkable decrease of pain.29 out of the 197 cases had complete rotator cuff tears and 51 cases who had severe limitations of R. O. M. decreased their pain which was parallel to the improvement of their R. O. M. s.76 cases had other dysfunctions. In conclusion, in order to treat the above cases, compensative muscle activities for a rotator cuff tear, direct approach to dysfunctions for an impingement, and decrease the obstruction of pass for an edema of the cuff were required.
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  • with Arthroscopic Findings.
    Katsumi SATO, Koji ISHIBASHI, Syoji YOSHII, Minoru HASHIMOTO, Tadao OJ ...
    1998 Volume 22 Issue 2 Pages 327-330
    Published: June 25, 1998
    Released on J-STAGE: November 20, 2012
    JOURNAL FREE ACCESS
    Techniques and clinical results of arthroscopic surgery for an anterior dislocation or subluxation of the shoulder are influenced by the adhesion between the ligament-labrum complex (complex) and the anterior glenoid wall. The present study was undertaken to determine whether the adhesion could be predicted by CT-arthrography (CT-A).
    CT-As of 103 patients with 51 recurrent anterior dislocations,49 subluxations and 3 initial anterior dislocations were analyzed. The patients were 74 males and 29 females, aged from 13 to 50 years (mean 23).
    CT-A findings were classified into three types. Type A: with Air adjacent to the anterior glenoid s urface, type B: with Bony fragment and type S: with a Soft tissue shadow on the anterior glenoid. Adhesion of the complex to the glenoid wall was confirmed by arthroscopic observations.
    Fifty-one cases were classified as type A. Thirty were as type B and the othe r 22 were as type S. No adhesion was found in type A, while the bony fragment was firmly attached to the glenoid in type B cases. The detachment procedure of the adherent complex from the anterior glenoid was necessary in arthroscopic Bankart's repair in 18 cases of type S (82%). The diagnostic values of type A and type S were as follows: sensitivity=81.2%, specificity=100% and accuracy=94.5%
    Among 51 cases with type A,76% of the cases were di agnosed as recurrent dislocations. Among those with type B and type S, the ratios of dislocation were 20% and 32%, respectively.
    The adhesion between the complex and the anterior glenoid can be predicte d by CT-As focusing on air and the soft tissue shadows adjacent to the anterior glenoid wall.
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  • Hitoshi TERUYA, Kunio IBARAKI, Jun HASHIMOTO, Naoki IMADA, Katsuya NOB ...
    1998 Volume 22 Issue 2 Pages 331-335
    Published: June 25, 1998
    Released on J-STAGE: November 20, 2012
    JOURNAL FREE ACCESS
    The purpose of this study was to evaluate the relationships between an A-P translation of the humeral head and the function of the glenohumeral ligament.
    Thirty-five shoulders with anterior instability diag nosed by operative findings were examined. The subjects consisted of 10 shoulders with rotator interval lesions without a Bankart lesion (RIL group ). and 25 shoulders with Bankart lesions (Bankart group ). The normal 20 shoulders were evaluated as the control.
    In cinerthrography, the joint kinetics of rotational motion in the 2nd plane on axial views were recorded. The motion of the shoulder joint was from the neutral position to maximun external rotation at 90 degrees of abduction. Using an image analyzing system, the displacement of the center of the humeral head and the rotation of the glenohumeral joint were calculated in each position.
    Control group : The displacements of the humeral head were small with trends in the posteroir direction by external rotation.
    RIL group: The humeral head translated anterioly 60-80 degrees inan external rotation, and posteriorly in the following an ER (rebound phenomenon).
    Bankart group: Anterior translations only could be obse rved in the ER However 4 shoulders with normal MGHLs and IGHLs had the reboundphenomenon in 90-100 degrees ER.
    At 90 degrees abduction, the IGHL plays a role in limiting anterior tran slation mainly in the late stage of an external rotation, and the MIGL plays the role of anterior stabilizer in the early stagesof an ER.
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  • Kou MIMORI, Kenichi SHINOMIYA, Teruhiko NAKAGAWA, Takayuki SUGIHARA
    1998 Volume 22 Issue 2 Pages 337-340
    Published: June 25, 1998
    Released on J-STAGE: November 20, 2012
    JOURNAL FREE ACCESS
    We assumed that pain provoked by an anterior apprehension that varies with theposition of the forearm, and this difference can be useful when diagnosing a superior labral lesion. We investigated the value of this pain provocation test in throwing injuries of the shoulder.
    The subjects consisted of 32 patients who were diagnosed w ith throwing injuries of the shoulder. There were 30 males and 2 females (mean age,20.9 years). patients with a rotator cuff tear in the MRI or arthrography or with a dislocation of the glenohumeral joint were excluded from this study. We studied the severity of pain provoked by an anterior apprehension test in two different positions of the forearm: pronation and supination, and compared the findings of the MR arthrography with the results of the pain provocation test.
    In 22 cases, detached superior labrums were observed in the MR arthrogram. All these cases complained of more severe pain when their forearms were pronated. On the other hand, a detached anterior labrum only in the MR arthrogram was observed in one case. In this case, the pain did not change regardless of the forearm position. The other 9 cases had no labral tears in their MR arthrograms, and only one case out of the 9, complained of increased pain in the pronated position.
    We defined this pain provocation test as positive when pain occurred only in pronation or the pain in pronation was more severe then that in supination. The values of this pain provocation test were as follows: sensitivity 100%, specificity 89% and accuracy 95%. This test seems to be most useful in predicting a superior labral tear.
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  • Hiroshi SEKI, Minoru YONEDA, Akira MAEDA, Keiko KAGAYA, Hiroshi NOGUCH ...
    1998 Volume 22 Issue 2 Pages 341-345
    Published: June 25, 1998
    Released on J-STAGE: November 20, 2012
    JOURNAL FREE ACCESS
    We evaluated shoulder joint laxity under general anesthesia in patients with various extents of anterosuperior labral tears to clarify the role of anterosuperior labrum for shoulder stability. We studied forty-five cases of patients with anterosuperior labral tears in arthroscopic surgery. Based on the detached portion of the glenoid rim, we classified the labral tears into four types, which consisted of “superior type”, “anterosuperior type”, “wide-anterosuperior type” and “anteroinferior type”. The shoulder held in the scapular plane at 30° and 90° of abduction under general anesthesia and an anterior or posterior force was applied manually to the humeral head. Inferior translations were assessed using the sulcus test by applying an inferior force to the arm. The amount of anterior and posterior translations were graded into five degrees, and inferior translations into three degrees. If the symptomatic shoulder had a higher degree than the third of an anterior or posterior laxity and a higher degree than on the other side, we defined the instability as positive. Then we classified the anterior or posterior instabilies into two categories: “30A/30 P” and “90A/90P”.30A/30P shoulders had a laxity of 30° abduction which were equal or superior to that of 90° abduction.90A/90P shoulders had inverse laxities. Inferior instabilites were defined as positive when an inferior laxity of the symptomatic shoulder had a higher degree then on the other side. Anterior instability evaluations were nine-30A and eighteen-90A. Posterior instability was positive in eight cases and inferior instability in seven cases. As assessed according to the extent of the lesion, all ten cases of superior type were negative. Of ten cases of anterosuperior type, four were 30A and one was 90A. Of the seven cases of wide-anterosuperior type, therr were 30A, two were 90A and inferior instability was positive in five. there were fifteen-90A of the eighteen cases of anteroinferior type. We concluded that shoulder anterior instability seemd to vary according to the extent of anterosuperior labral tears on evaluation under general anesthesia.
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  • Kenji OKAMURA, Toshiaki HIROSE, Keiko KAGAYA, Sunao FUKUSHIMA, Akihiko ...
    1998 Volume 22 Issue 2 Pages 347-350
    Published: June 25, 1998
    Released on J-STAGE: November 20, 2012
    JOURNAL FREE ACCESS
    (Purpose) The purpose of this study was to evaluate the diagnostic value of air CT arthrography for SLAP lesion of the shoulder joints.
    (Patients & Methods) We studied 184 shoulders that underwent operative findings. One hundred and forty-one shoulders were anterior instabilities,26 shoulders were SLAP lesions and 17 shoulders were both in preoperative diagnosis. The mean age at operation was 23 years (15-40). Air CT arthrography was performed prior to surgery. Type 2 SLAP lesion was diagnosed by existence of trapped air sign between superior labrum and glenoid rim.
    (Results) Type 2 SLAP lesion were diagnosed in 33 shoulders by air CT arthrography. According to Snyder' s classification,14 shoulders were type 1,49 shoulder were type 2,4 were type 3 and one shoulder was type 4 in operative findings. Air CT arthrography demonstrated 55% sensitivity,94%specificity and 84% accuracy in the diagnosis of type 2 SLAP lesion.
    (Conclusions) Air CT arthrography were useful for preoperative diagnosis of type 2 SLAP lesion.
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  • Yoshinori TAKUBO, Motoyuki HORII, Masao KUROKAWA, Mikihito TAMAI, Yasu ...
    1998 Volume 22 Issue 2 Pages 351-354
    Published: June 25, 1998
    Released on J-STAGE: November 20, 2012
    JOURNAL FREE ACCESS
    The purpose of this current study was to investigate the usefulness of MR imaging for diagnosing SLAP lesions. Thirteen painful shoulders were examined. Ten athletes had SLAP lesions, three athletes involved in throwing activities did not have SLAP lesions. Oblique coronal sections of T2*weighted images were obtained using a superconductive MR imager(Shimadzu). The superior labrum was evaluated and classified into 6 types. Type A demonstrated a focal high-intensity on the articular side. Type B showed high-intensity across the whole width of the superior labrum. Type C showed a low area within the high-intensity area. Type D demonstrated a high-intensity band from the glenoid to the biceps tendon, while Type N only showed a low-intensity or partial high-intensity line at the attachment of the superior labrum. Type L showed a high-intensity line along the whole attachment. These MR findings were compared with arthroscopic findings evaluated by Snyder' s classification. One shoulder with type A in MR imaging showed a type III SLAP lesion. Type B showed a type I in one patient and type II in five. Type C showed type II in two. Type D showed type I in one patient. In types N and L, there were no SLAP lesions in two or one patient, respectively. SLAP lesions demonstrated type A, B, C or D on MR imaging, but not type N or L. Type B was the most frequent type of type II SLAP lesion.
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  • Yasuo GOTOH, Nariyuki MURA, Masahiko MATSUDA, Yoshiyuki MOMONOI, Toshi ...
    1998 Volume 22 Issue 2 Pages 355-358
    Published: June 25, 1998
    Released on J-STAGE: November 20, 2012
    JOURNAL FREE ACCESS
    The purpose of this study is to evaluate the function of asymptomatic shoulders in the aged and to investigate the changes of function with aging.
    The materials for this study were 474 persons who were older than 65 years. There were 197 males and 277 females with an average age of 73 years (65 to 93). Shoulder pain, active ROM and isometrical muscle strength of abductions were evaluated. Muscle strength was measured by using a Microfet. The relationships between aging and the changes of shoulder function were investigated in the aged with an asymptomatic shoulder.
    Thirty-eight m ales (19.3%) and 70 females (25.3%) had some disorder of the shoulder, while 159males and 207 females had no complaints. The average range of anterior elevation of the right shoulder was 158 degrees in males,157 degrees in females, aged from 65 to 69 years old, and significantly decreased with aging. The average strength of abduction of the right shoulder was 86N in males,54N in females, aged from 65 to 69 years old, which also significantly decreased with aging. However, the average range of external rotation and internal rotation did not significantly decrease with aging. The above results applied to the left shoulder.
    We discovered the range of active ROM and of muscle strength of a shoulder abduction in the aged with asymptomatic shoulders. The average range of an anterior elevation and muscle strength of an abduction significantly decereased with aging.
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  • Tohru OKUWAKI
    1998 Volume 22 Issue 2 Pages 359-362
    Published: June 25, 1998
    Released on J-STAGE: November 20, 2012
    JOURNAL FREE ACCESS
    [Purpose] We evaluated the shoulder alignment by measuring the sloping angles of shoulders. Materials and Methods: Photos were taken of 362 male sloping anglesof their shoulders were measured on the photos. The angle was measured by two lines; one line was drawn from the neck to the acromion. The other line was drawn between bilateral acromions. All the athletes were evaluated their shoulder type by three methods. First, they gave their impressions of their own shoulders. Secondly, they were evaluated by seven trainers. Thirdly, Iseki's method of measuring sloping shoulders was used to evaluate the position of the acromion in relation to the upper edge of the sternum. The athletes were also questioned about their shoulder injury history and the sports they played.
    [Results] The average sloping angle was 24.2 ±3.6° on the right side,25.1 ±3.7° on the left side. There was no lateralization. According to the trainers evaluation 42 cases (12%) displayed sloping sh oulders, the so called nadegata type; 98 cases(27%) had square shoulders, ikarigata; and the remaining 222(61%) were classified as namigata. The sloping angle was 28.2±2.6° in nadegata,25.0±2.7° in namigata and 20.9±3.1° in ikarigata. The angles of the three groups were all significantly different. The angles of the gymnasts were the greatest and the angles of the swimmers and the volleyball and soccer players were the smallest. There was no difference between the angles of athletes with shoulder injuries and those with no injuries.
    [Conclusion]The measurement of the sloping angle of shoulders is useful for the evaluation of shoulder alignment.
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