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Noboru FUKUDA, Katsuya NOBUHARA, Jun HASHIMOTO, Takashi HASHIMOTO, Mas ...
2002 Volume 26 Issue 2 Pages
185-188
Published: 2002
Released on J-STAGE: January 18, 2008
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[Purpose] The purpose of this study was to evaluated the findings of MR imaging (MRI) of asymptomatic shoulder.
[Materials and methods] MR images of 60 shoulders of 60 healthy subjects (6 males and 6 females in every decade between twenty and sixty) were used as materials. MR imaging was taken with SIEMENS 0.2T open MRI using a shoulder joint surface coil. Oblique coronal plane and axial plane images by T1-Weighted spin echo images (TR/TE:920/26) and T2
*-gradient echo images (TR/TE/flip angle:742/17/60) were analyzed.
[Result] High signal intensities of the supraspinatus tendon that looked like rotator cuff tear on the oblique coronal plane by T2
*-images were found in 30 shoulders. In each decade, these findings were found in 2 shoulders in their twenties, 5 shoulders in their thirties, 5 shoulders in their forties, 8 shoulders in their fifties and 9 shoulders in their sixties. There was a significant difference between the appearance of this finding and aging (P<0.05). A high signal intensity area was located in 8 Bursal sides, 5 intratendinous, 5 articular sides and 11 full thicknesses. Cystic changes in the posterior greater tuberosity were noted in 25 shoulders, in 17 males (the mean size of the cystic change was 4.2±2.2mm) and in 8 females (the mean size of the cystic change was 2.3±0.7mm). There was a significant difference between the appearance of cystic change and the distinction of sex (P<0.05).
[Conclusions] It is recognized that MR imagings show high signal intensities of the supraspinatus tendon that seem to be rotator cuff tear in some cases. We presumed this result is related to the degeneration of the rotator cuff, little effusion of the subacromial bursa and magic angle phenomenon. A cystic change in the posterior part of the greater tuberosity was observed more frequently in males.
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(The Second Report)
Yutaka MORISAWA, Tetsuro SADAHIRO
2002 Volume 26 Issue 2 Pages
189-193
Published: 2002
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MRI observations of the rotator cuff tear showing a high signal intensity on the supraspinatus muscle belly (SMB) were examined before and after surgery.
The subjects were eleven patients a the massive and global rotator cuff tear of the shoulder aged between 52-76 years old (mean, 65.4 years old). They revealed a high signal intensity on the SMB when compared to the trapezius muscle belly in T2-weighted images using an MRT-200FX, 1.5T (Toshiba) or a GE Signa, 1.5T.
Their pre- and post- operative conditions were evaluated according to their JOA score, and a high signal intensity of the SMB on MRI was observed after surgery.
No remarkable changes in the intensity of the SMB on MRI in the nine cases with high post-operative JOA scores. On the other hand, in the two cases with low points, the high signal intensity had increased.
A persistent tear of the rotator cuff causes fibrosis and fatty degeneration in the SMB with a high signal intensity on MRI through the post-operative periods.
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-A Cadaveric Study-
Hideyuki GOTO, Hiroya SENDA, Shinji HISAZAKI, Masahiro NOZAKI, Mariko ...
2002 Volume 26 Issue 2 Pages
195-198
Published: 2002
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Several postoperative complications, such as an acromial fracture and a joint contracture have been reported following a fixation by Wolter clavicular plate. The purpose of this study is to analyze the motion of acromioclavicular joint (ACJ) after the fixation by Wolter clavicular plate. In this study, five shoulders from three cadavers were used. Three models, which were control (without a fixation), dislocation (acromioclavicular ligament and coraoclavicular ligament were released), and fixation (fixed with Wolter clavicular plate) were established. The movements of the acromion relative to the distal clavicle were measured and expressed as changes in angle on the sagittal plane (SA) and horizontal plane (HA) at 45° and 120° flexion or 45° and 120° abduction. In the control model, the mean values of SA and HA at 120° flexion were 18.2° and 11.5° and SA and HA at 120° abduction were 11.2° and 9°, respectively. In the dislocation model, the motion of ACJ increased in flexion compared with the control model. On the other hand, in the fixation model, SA and HA at 120° flexion were 5.4° and 5.8° and SA and HA at 120° abduction were 9.8° and 3.6° indicating decrease in motion of ACJ compared with the control model. This study indicated that a fixation by Wolter clavicular plate restricted the motion of acromioclavicular joint.
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Kimio NAKAGAKI, Goro SAKURAI, Tomohisa HASHIUTI, Jiro OZAKI, Yasuharu ...
2002 Volume 26 Issue 2 Pages
199-202
Published: 2002
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Percutaneous Kirschner wire fixation for early exercises in dislocations of the acromioclavicular joint were carried out. A 3mm Kirschner wire was passed percutaneously under the acromion and into the clavicle after closed reduction in three patients. The arm was elevated after the arm was supported in a sling for 2 weeks. The wires were removed at 8 weeks after the operation. In two patients, subluxation of the acromio-clavicular joint has recurred after pin removal. Only one patient maintained a normal acromio-clavicular joint after surgery.
There was no patient with a breakage of Kirschner wire. Osteoarthritis did not observed in any patients. A wire migration was occurred in a 78-year old patient. Percutaneous Kirschner wire fixation passed under the acromion into the clavicle in an acromioclavicular dislocation was easy to perform and useful. But we do not recommend this method for older patients with osteoporosis.
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Jun ITOU, Hideo NISIKAWA, Ai ASIHARA, Keizou MORISAWA
2002 Volume 26 Issue 2 Pages
203-207
Published: 2002
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We have used a BEST acromioclavicular plate for surgical treatment of acromioclavicular joint dislocation.
We will report on the post operative results. 10 patients (10 males) who were treated between 1999 and 2001 with a BEST acromioclavicular plate. The mean-age of the cases was 42 years oid ranging from 24 to 72 years old and the follow-up periods were 1 to 17 months. The clinical results were evaluated by Kawabe's scoring system and the JOA shoulder rating system. The average JOA score was 88.3 points. The average Kawabe's score was 87.4 points. There was one patient JOA score was 88.3 points. The average Kawabe's score was 87.4 points. There was one patient who had an expanded hook hole. We had satisfactory clinical results in this study. The BEST acromiocavicular plate was firmly fixed to the acromioclavicular joint. We werre caraful to have an early ROM tyaining and expanded hook hole.
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Sumito SAKURADA, Kenji TSUBO
2002 Volume 26 Issue 2 Pages
209-212
Published: 2002
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The purpose of this study was to evaluate the clinical results of conservative treatment for distal clavicle fractures. Twenty patients with acute distal clavicle fractures were treated from 1998 to 2000. There were 12 males and 8 females and the mean age was 47.5 years old. According to Neer's classification, 3 fractures were Type I, 14 Type II and 3 Type III. We tried closed reduction at the beginning. When the reduction was achieved, a brace was applied. All the patients were evaluated by X-ray findings, symptoms, and their JOA scores. Bone unions were obtained in all Type I and Type III cases. In Type II cases, 4 cases achieved good bone union. However in the remaining 10 Type II cases, malunion occurred in 5, and nonunion in 5, there were few symptoms and none of the patients had any disability. We recommend that a distal clavicle fracture be treated conservatively if possible.
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Kazushige TERADO
2002 Volume 26 Issue 2 Pages
213-218
Published: 2002
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The purpose of this study was to evaluate the results of tension-band wiring technique for type 2 fractures of the distal clavicle. From 1991 to 2000, 19 consecutive Type 2 fractures of the distal clavicle were treated with the tension-band wiring technique using two Kirschner wires. The average age of the patients was 45.4 years old (range 14 - 73). There were 12 males and 7 females and the average follow-up period was 2 years and 4 months (range 7months - 6years and 5months). All the shoulders were assessed retrospectively, and scored using the JOA shoulder scoring system. Eighteen fractures eventually achieved union and one had a non-union. One case of non-union was asymptomatic. At the final follow-up, the average JOA score was 94.7 (range 60.5 -100) and only one case with an ipsilateral rotator cuff tear showed poor results. Five shoulders had some pain in the acromioclavicular joint, and 4 of them had acromioclavicular subluxations radiographically. Five shoulders showed subluxations of the acromioclavicular joints radiographically and 4 of them were symptomatic. Six shoulders had loss of active flexion and 4 of them had acromioclavicular subluxations. Distal migration of Kirschner wire had occurred in 7 of 19 patients and 4 of them required removal of the hardware early in the postoperative period, but the migration of Kirschner wires were not correlated with the final JOA scores. Tension-band wiring has the advantage of sufficient fixation for a Type2 fracture of the distal clavicle. However in our series, it may be problem that some cases had acromioclavicular subluxations with pain and loss of shoulder flexion.
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Takahito HOTTA, Katsumi TAKASE, Koutaro SHINMURA, Atsuhiro IMAKIIREI
2002 Volume 26 Issue 2 Pages
219-223
Published: 2002
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The aim of this study was the outcome of surgical treatment for an unstable distal clavicle fracture (Neer's type II) using a Wolter clavicular plate (W-plate) and BEST acromioclavicular plate (B-plate) which were compared. The subjects were 28 patients, (W-plate : 17, B-plate : 11) whose mean age was 39 years old. The postoperative follow-up period ranged from 8 to 32 months (mean, 15.5 months). The postoperative results were evaluated by JOA score. Bone union was achieved in all patients. In the W-plate group, the hook hole on the acromion was enlarged in all patients. In the B-plate group, the hook region impingement, occurring in 4 patients, when the arm was raised. The JOA score was 82-100 points (mean, 97.6 points) in the W-plate group and 76-100 points (mean, 93.4 points) in the B-plate group, showing no statistically significant intergroup difference. The plate should be removed as soon as the union is completed, because an acromial fracture may possibly occur due to the enlargement of the hook hole when a W-plate is used, and because the hook region of a B-plate leads to a high incidence of impingement of the hook region when the arm is raised.
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Takayuki SUGIHARA, Teruhiko NAKAGAWA, Kou MIMORI, Masafumi ISHIZUKI, K ...
2002 Volume 26 Issue 2 Pages
225-228
Published: 2002
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The purpose of this study was to investigate the clinical results and the influencing factors on the post-operative results of a rotator cuff tear.
20 shoulders with rotator cuff tears were operated on from 1999 to 2001 in our hospital and followed-up for 6 to 17 months (average 11.0 months). There were 11 males and 9 females with an average age of 59.1 years old. The pre- and post-operative results according to the shoulder evaluation sheet of the Japanese Orthopaedic Asociation (JOA score) were evaluated. The rate of improvement of JOA score in relation to the size of the tear, age at operation, time between the onset and operation were investigated.
The average pre-operative JOA score was 65.9 points and the average post-operative JOA score was 92.3 points. The average post-operative JOA score improved compared with the pre-operative JOA score statistically. The rate of improvement of the JOA score showed no correlation with the size of the tear, the age at operation, the time between the onset and operation statistically.
The clinical results of surgical treatment for rotator cuff tears in our hospital were satisfactory.
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Yasuo GOTOH, Nariyuki MURA, Yoshiyuki MOMONOI, Daisaku TSURUTA, Toshih ...
2002 Volume 26 Issue 2 Pages
229-232
Published: 2002
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There are some patients with rotator cuff tears whose grip strength is much smaller in the same side as the torn cuff than in the normal side. The purpose of this study was to investigate the significance of weakness of the grip strength in rotator cuff tears. The materials for this study were 22 patients who had a rotator cuff tear of the shoulder and were normal in the other shoulder. There were 14 males and 8 females with an average age of 58 years old. Isometric muscle strength around the shoulders was measured by using a MicroFET, and grip strength was done by using a dynamometer. The ratios of the muscle strength of the affected side to the one of the normal side were calculated. The materials were divided into two groups : Group A consisted of patients whose grip strength of the affected side were less than 80% of the normal side. Group B consisted of the other patients. Grip strength had a significant correlation with muscle strength of 45 degrees shoulder abduction and external rotation in the patients with rotator cuff tears. There were 9 patients in group A and 13 in group B. The ratios of the muscle strength of the affected side to the one of the normal side were as follows : 45 degrees abduction ; 0.259 in groupA, 0.559 in groupB (p=0.048), 90 degrees abduction ; 0.205 in groupA, 0.380 in groupB (p=0.158), external rotation ; 0.455 in group A, 0.731 in groupB (p=0.082). Weakness of grip strength in the cuff tear side indicated a greater loss of muscle strength of 45 degrees shoulder abduction.
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Yozo SHIBATA, Koji MIDORIKAWA, Noriaki HONJO, Masatoshi NAITO
2002 Volume 26 Issue 2 Pages
233-238
Published: 2002
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Usually, surgical results of McLaughlin's procedure for a rotator cuff tear are excellent. But, sometimes, it is difficult to detect the cuff stump or it is impossible to suture it, due to a massive rotator cuff tear. We reported on the surgical results of patients with a massive rotator cuff tear, which were sutured through the new trans-acromial approach. Five men and one woman were sutured a torn cuff through the new trans-acromial approach, It was impossible to suture the patients with conventional Neer approach. The base of the acromion was dissected with a T-saw vertical to the spine of the scapula. After the osteotomy and the sprit of the acromio-clavicular joint, the acromion was turned over. It was very easy to release the cuff stump and the capsule surrounding the glenoid. After suturing the cuff stump to the bony trough on the humeral head, the acromion was fixed with a pin wire (Zimmer co.). The average follow-up was 14 months. The average width of the cuff was 5 cm, and its average length was 6 cm. The ranges of motion of the shoulder and the JOA scores were studied before and after the surgery. The averages 70 degrees of elevation, 37 degrees of external rotation, L1 of internal rotation before surgery. The average 130 degrees of elevation, 30 degrees of external rotation, L2 of internal rotation after surgery. The average pain score had improved from 11 points to 25 points, the average JOA score was 56 points before surgery, and 81 points after it. Delayed union of the acromion was observed in 2 patients, and irritation of the pin was in one. Three patients had difficulty to reach the opposite shoulder with their hand, one patient could not adduct her arm. The new trans-acromial approach is a useful procedure for a massive rotator cuff tear.
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-Results of Cases with a Bone Trough Made at the Top of the Humeral Head-
Naomi OIZUMI, Naoki SUENAGA, Akio MINAMI, Hiroyuki KATO, Shintaro YAMA ...
2002 Volume 26 Issue 2 Pages
239-244
Published: 2002
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We have performed McLaughlin's procedure for massive rotator cuff tears if the torn tendon could reach the top of the humeral head. The purpose of this study was to investigate the clinical and roentgenological results of the cases with a bone trough made at the top the humeral head. Twenty-five patients treated by the current procedure were examined. There were 15 males, and their age at the operation averaged 62.2 years old (range : 39 to 74 years old.). The clinical results were evaluated by the shoulder score of the Japanese Orthopedic Association (JOA score). Osteoarthritis (OA) of the glenohumeral joint was classified with four grades. Superior migration of the humeral head was classified from grade 0 to III. The follow-up period averaged 44 months (range : 24 to 80 months). The JOA score at the final follow-up averaged 90.2 points. Fourteen cases were classified as excellent, 9 good, 1 fair, and 1 poor. ROM of the shoulder at the follow-up was 120°∼170° in flexion, -10°∼75° in external rotation, and T4∼L4 in internal rotation. The OA changes had progressed in 7 cases (28%), and the superior migration of the humeral head had progressed in 6 cases (24%). Superior migration of the humeral head had improved in only 3 cases. Successful clinical results were obtained when the torn tendon was repaired just distal to the top of the humeral head. However, long-term follow up is necessary to evaluate this procedure because the progression of OA changes of the glenohumeral joint were found in some cases.
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Katsumasa SUGIMOTO, Hiroshi TOMITA, Naoko OYABU, Yokio NAKANO, Naoya T ...
2002 Volume 26 Issue 2 Pages
245-248
Published: 2002
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The long-term results (over 5 years) of arthroscopic Bankart suture repair were demonstrated in this report. Thirty patients with recurrent anterior shoulder instability underwent an arthroscopic Bankart suture repair (Craig Morgan technique, transglenoid absorbable suturing technique) : 20 patients were males and 10 patients were females. The average age at operation was 23.2 years (range 16-39 years old). The postoperative follow-up averaged 99.5 months. At arthroscopy, all 30 patients were found to have Bankart lesions. All had had an anterior apprehension sign pre-operatively. We could observe 26 patients in this series post-operatively. The anterior apprehension sign disappeared post-operatively in 21/26 cases. Two patients had recurrent dislocation postoperatively, and another three had recurrent subluxations. No complications (infections or neurologic injuries) occurred in this series. Arthroscopic Bankart suture technique appeared to be useful for a recurrent anterior shoulder instability.
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Ryutaro FUJII, Masanori OBATA, Kenji HAYASHIDA, Sunao FUKUSHIMA, Minor ...
2002 Volume 26 Issue 2 Pages
249-252
Published: 2002
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We wish to report on long term follow-up results of Caspari method for traumatic anterior shoulder instability.
Fifty-four of 127 patients, who underwent Caspari method, were followed for more than 5 years and reviewed. The mean follow up period was 75.5 months (60-100). The Bankart lesions were classified into 5 types according to the arthroscopic findings. Type1, type2, type3, type4, and type5 were seen in 12 patients, in 20, in 14, in 1, and in 7 respectively. Only absorbable sutures were used for 32 patients, and both absorbable and nonabsorbable sutures were used for 22 patients. According to Rowe's evaluation, 39 patients were excellent, 4 were good, 6 were fair, and 5 were poor. The 11 patients scored as fair and poor were recurrent, and the recurrent rate was 20.4%. Recurrence was seen in 3 of 12 patients in type 1,3, of 20 in type2.2 of 14 in type 3, 0 of 1 in type4, and 3 of 7 in type 5. The recurrent rate was high (31%) in the absorbable suture alone, and was low (5%) in the mixed sutures. The long term recurrent rate of Caspari method was 20.4%. The recurrent rate was high in absorbable suture alone and was low in the mixed sutures. The recurrent rate of mixed sutures was compatible with an open Bankart procedure.
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Tatsuo SATO, Hidekazu TOGA, Nobumasa SHIBA, Atsushi SAWAMOTO, Naoki HA ...
2002 Volume 26 Issue 2 Pages
253-256
Published: 2002
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Since 1984 we have used a combined Bankart-Bristow procedure for recurrent anterior dislocation of the shoulder. We investigated the long-term results by direct examination of the patients. We evaluated 75 patients, 78 shoulders, who were followed -up for more than five years post-operatively. The average age at the time of operation was 24 years old (range15-53 years old), and the average follow-up period was 9.6 years (range5.0-16.4 years). All the patients had a physical and X-ray examination. The following parameters were evaluated using the JSS Shoulder Instability Score and the JSS Shoulder Sports Score. One shoulder had a re-dislocation and another had a subluxation. The recurrence rate was 2.6%. The mean loss of external rotation compared with the opposite side was 16.4 degrees. Radiographs revealed osteoarthrotic changes of the glenohumeral joint in two shoulders. In both cases, arthrosis was mild. The return to heavy contact sports was achieved in 28 of 32 patients (87.5%). The average JSS Shoulder Sports Score was 86.5 points (range54-100points). The average JSS Shoulder Instability Score was 95.4 points (range72-100points). We concluded that this procedure gave good results for a recurrent anterior dislocation of shoulders with a low recurrence rate and a high rate of returning to heavy contact sports activities.
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Kazuhiro TAKAHARA, Masao ETO, Tadashi TOMONAGA, Masahiro WADA, Hiroyuk ...
2002 Volume 26 Issue 2 Pages
257-261
Published: 2002
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Since 1967, we have carried out a modified Bristow procedure for treatment of a recurrent anterior shoulder dislocation. The purpose of this study was to investigate the clinical long term results of this procedure. The materials were 38 shoulders of 38 patients at a minimum follow-up period of five years. 30 patients were male and 8 patients were female. The mean follow-up period was 9 years and 2 months. All the patients had physical and X-ray examinations.
The objective results were examined according to the JOA score and also by Carter Rowe's criteria. In our series, the redislocation rate was 2.6%. The mean loss of external rotation was 7.6 degrees. The average JOA score was 94.9 points. 25 shoulders (92.1%) had 90 points or more. Rowe's criteria had excellent results for 84.2%, good for 10.5%, and poor for 5.3%. 9 shoulders had screw trouble and a non-union in the X-rays. There were 4 loosening screws, 3 broken screws and was 1 escaped screw. Non-unions were found in 4 cases.
From these results, it could be suggested that a satisfactory result can be achieved by a modified Bristow procedure for the treatment of a recurrent anterior shoulder dislocation.
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Hidetoshi KANEKO, Nobumasa OMIBUCHI, Jun ISHII, Nobutake KATO, Shinich ...
2002 Volume 26 Issue 2 Pages
263-266
Published: 2002
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Based on this follow-up study, we attemped to investigated the long term results of our modified Bristow procedure. We could make a follow-up study of 57 patients over 5 years. 43 were male, and 14 female. The mean age at operation was 26.1 years old. The average follow-up period was 11 years and 3 months. 42 (73.6%) patients had sports injury episodes in the first dislocation. The clinical and radiological results were evaluated. The recurrence of dislocation was seen in only one patient. The anterior instability was found in 9 (15.7%) patients. Pain in motion was experienced by 3 patients. The mean limitation of external rotation was 10.1 degrees compared to the intact side. The average point of the pre-operative JOA score was 63, and 95.3 points post-operatively.
Radiographic findings revealed a broken screw in 3, a loosening screw in 4, and a non-union of the transferred coracoid process in 3. Arthrosis in 3. Arthrosis of the shoulder joint was observed in 8 patients. The Modified Bristow procedure had good results for the long term.
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Yutaka HIROTA, Shintaro TACHIBANA, Tomofumi AIZAWA, Junichi INOUE
2002 Volume 26 Issue 2 Pages
267-269
Published: 2002
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It was our purpose to evaluate the long-term resulst of our modified inferior capsular shift procedure (MICS) for recurrent traumatic anterior instability of the shoulder. 18 patients (15 males and 3 females) had MICS performed with capsulorrhaphy in 10 degrees external rotation position. Follow-up periods were from 5 years to 10 years 2months (average 6years 6months). Before surgery 17patients had difficulties in activity of daily living. Ten patients were athletes at a recreational level. We evaluated difficulties in activity of daily living, return to sports and the patients satisfaction after sugery. One patient had subluxation after surgery and 2 patients feeled apprehension when their arm was extended. Nine of 10 patints resumed their recreational level of sports. All the patinets were satisfied with surgery.
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Yoshiyasu UCHIYAMA, Masaru MAEDA, Tomotaka NAKAJIMA, Kunihiko KOBAYASH ...
2002 Volume 26 Issue 2 Pages
271-275
Published: 2002
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Our purpose to the clarify long-term postoperative results of recurrent anterior dislocations and subluxations after Neer's modified inferior capsular shift procedure (MICS) and the risk factors causing their recurrences. Ninety-five patients (96 shoulders, 79 males and 16 females, 62 dislocations and 34 subluxations) were examined directly and by phone more than 5 years after MICS (ave. 82 mos. ; 5-12 yrs.). The post-operative results were evaluated by a manual translation test, an apprehension test, ROM, Rowe's score at their final follow-up. Risk factors causing postoperative recurrence of dislocation or subluxation were clarified. General joint laxity (GJL) was seen in 10 (11%) patients. There had 43 (45%) contact sports players and 44 (46%) patients were competitive level players. Postoperatively, 8 cases (8.3%) were recurred. Five (8%) and 6 (10%) patients showed positive anterior apprehension and anterior translation tests. The average ROM loss was 1.1° in elevation, 9.9° in the external rotation at the side and 9.3° in the external rotation at 90° abduction. The Rowe score at the final follow-up showed excellent in 72 (75%), good in fourteen (15%), fair in three (3%), and poor in seven (7%) patients. Five items [preoperative factors; subluxation, positive GJL, contact sport players, competitive sports level and intraoperative factor: arm-position at capsulorrhaphy (20≤ER)] were considered to be risk factors of a recurrence. The recurrent rate was 8.3 % over 5 years after MICS. It was recommended that patients having preoperative risk factors should be operated with 10° ER capsulorrhaphy.
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Toyohisa NANIWA, Kiyohisa OGAWA, Hiroyasu IKEGAMI, Wataru INOKUCHI, No ...
2002 Volume 26 Issue 2 Pages
277-282
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[Purpose] When nonunion of the surgical neck of the humerus develops in osteoporosis patients, it tends to cause cavitation to occur in the head of the humerus. In this study we assessed the tension band wiring that we performed to treat patients with a cavitation.
[Materials & Methods] The subjects were 5 patients, 1 man and 4 women, age range 62-76 years old. The procedure consisted of bone grafting followed by insertion of Kirschner wires (K-wires) at the sites of the tendon insertion in the tubercles and two tension band wirings were performed
[Results] Bone fusion was observed in every case. However, pain during movement and nocturnal pain due to subacromial impingement by the K-wire during aftercare were noted in two cases. The symptoms improved after the pins were removed. Shortening of the length of the humerus and limitation of range of motion were observed, but none of the patients experienced pain in their daily lives, and they all recovered to the point where they were able to return to their occupation or level of living before the injury.
[Conclusion] The method in which tension band wiring is performed more than once, using both K-wires and soft steel wires, can also be applied to patients with cavitation in bone fragments of the head of the humerus. However, the sites of insertion of the K-wires are restricted, and there are aspects that should be improved, including the possibility of causing subacromial impingement during aftercare.
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Hiroyasu IKEGAMI, Kiyohisa OGAWA, Masaaki TAKAHASHI, Wataru INOKUCHI
2002 Volume 26 Issue 2 Pages
283-286
Published: 2002
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We investigated the results of surgical treatment for recurrent anterior dislocation of the shoulder in patients aged 50 years old and more. Ten patients aged 50 to 72 years old (9 women, 1 man) were reviewed. They were followed-up from 12 to 106 months after surgery. We studied the pathologic features and the treatment for each case. Also we estimated the results of surgery by using Rowe's scoring system. Bankart lesion with a bony lesion and an over medium degree Hill-Sachs lesion was observed in 5 patients who had the initial dislocation at under 50 (18 to 47 years old, average : 29 years old). We performed Bankart procedure on all the patients, and the results were excellent with a sore of 90 to 100. Three cases of rotator cuff tear were observed in 5 patients who had an initial dislocation at 50 years old and over (61 to 69 years old, average : 66 years old). Two of 3 cases were massive tears. Bankart lesions were observed in 3 patients. We repaired the rotator cuff tears and acromioplasty in 2 patients, and added a modified Bristow method in one of them. Also we performed Bankart procedure in the other 3 patients and added a modified Bristow method to one of them. The results showed a score of 75 to 90. Patients who had their initial dislocation at a young age often have Bankart lesion alone. In comparison with them, patients who had initial dislocation at 50 years old and over have the same pathological features as young people, and or with massive rotator cuff tears. It is important to grasp the pathological feature ahead of an operation, and to choose a suitable surgical treatment as to the operation for a recurrent anterior dislocation of the shoulder for middle-aged patients.
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-Comparison of an Immediate Repair and Delayed Repair (Second Report) -
Keiko KAGAYA, Mitsuhiro AOKI, Toshiro TAKIUCHI, Kenji OKAMURA, Seiichi ...
2002 Volume 26 Issue 2 Pages
287-290
Published: 2002
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We assessed the initial mechanical properties of repaired infraspinatus tendons after immediate and delayed repairs using #2 sutures. Fifteen shoulders were harvested from 8 beagle dogs, and were divided into two repair groups. Immediate repair group (group I) (n=8) : the insertion of the infraspinatus tendon was detached from the greater tuberosity and then sutured to the bone trough with 4-strand sutures (#2 Ethibond). Delayed repair group (group D) (n=7) : the insertion of infraspinatus tendon was detached from the greater tuberosity and retracted proximally. Five weeks later, the shoulders were harvested and the tendons were repaired in the same way as the immediate repair group. The ultimate strength and stiffness of each tendon was measured with a force transducer, and the pattern of the tendon disruption was also determined. The data were analyzed by one-way ANOVA and P <0.05 was regarded as statistically significant.
The average ultimate tendon strength was 155.7±35.7 (S.D.) N in group I and 170.7±53.6 (S.D.) N in group D, with no significant difference between the two groups (p=0.528). The average tendon stiffness was 18.5±12.8 (S.D.) KN/m in group I and 13.8±5.6 (S.D.) KN/m in group D, with no significant difference between the two groups (p=0.380). In group I, the tendon ruptured in 6 shoulders and suture loops in the tendon moved distally during traction in 2 shoulders. In group D, the tendon ruptured in 6 shoulders and the bone avulsed at the greater tuberosity in one shoulder. There was no difference in the initial mechanical properties between the immediate and delayed repair tendons after surgery using #2 sutures. A repaired rotator cuff tendon end at 5 weeks after detachment is expected to have clinically enough strength.
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-An Analysis using the 2D Finite Element Method
Hirotaka SANO
2002 Volume 26 Issue 2 Pages
291-295
Published: 2002
Released on J-STAGE: January 18, 2008
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In the surgical treatment of joint side incomplete rotator cuff tears, the role of the arthroscopic debridement has not been fully clarified yet. The purposes of this study were : 1. To clarify the stress distribution at the insertion in the supraspinatus tendon with joint side tears. 2. To clarify whether the stress distribution at the tendon insertion changes after debridement or not. A 2D finite element model of the normal supraspinatus tendon was used for this study. Three different sized joint side tears were created on the model (I-models). Moreover, models simulating state after the debridement were also created (D-models). Using the software, MARC 2001, a tensile load was applied at the proximal end of tendon and the stress distribution was analyzed. Then, both the pattern of the stress distribution and the maximum value of the von Mises stress in I-models were compared to those in D-models. In I-models, the von Mises stress concentrated at the site of incomplete tears. In D-models, the highest concentration of the von Mises stress was seen at the bottom of incomplete tears. From this site, the area of high stress concentration continued to the bursal side. In D-models, the pattern of the stress distribution was almost identical to that in the I-models. Moreover, the highest value of the stress concentration did not change significantly after debridement. These results were just identical irrespective the size of the incomplete tears. Biomechanical stress has been suggested as one of the pathogenetic factors for the rotator cuff tearing. Thus, it is desirable that the stress at the tendon insertion would decrease after debridement. However, our study revealed that the debridement of incomplete supraspinatus tendon tears did not improve the stress concentration at this site.
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Hiroaki INUI, Kazuomi SUGAMOTO, Takashi MIYAMOTO, Akitoshi MACHIDA, Ju ...
2002 Volume 26 Issue 2 Pages
297-301
Published: 2002
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Glenoid shape is closely related to shoulder stability and its abnormality is considered to affect the head position in shoulders with atraumatic instability. However, it still is unclear how the glenoid shape in shoulders with atraumatic instability is different from the glenoid shape in normal shoulders. The current authors investigated glenoid shape of 45 healthy individuals (20 males and 25 females ; 22 years on average) and 20 patients with atraumatic posterior instability with multidirectional laxity (six males and 14 females ; 19 years on average) using three-dimensional magnetic resonance imaging. The tilting angles of the glenoid bone were measured in five consecutive planes perpendicular to the long axis of the glenoid and cross sections were divided into three types (concave, flat, convex). In healthy individuals, the average tilting angles from the bottom to the top of the glenoid bone were 3.0±3.6°, 1.0±3.2°, -1.0±2.0°, -2.3±3.9°, -6.9±3.7° anteriorly, and those of patients were -6.1±4.0°, -4.0±3.6°, -4.8±3.2°, -5.5±2.7°, and -7.5±3.1°. The type of cross section also was different on the bottom plane where the concave shape accounted for 78% of healthy cases while it accounted for 0% of patients. The loss of tilting angles and concavity of the inferior glenoid would correlate with the direction of the head translation in posterior instability.
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-The Effects of Synovial Tisssue-
Kazuhiko KIKUGAWA, Yu MOCHIZUKI, Kenji KASHIWAGI, Takeo IMADA, Nobuyos ...
2002 Volume 26 Issue 2 Pages
303-308
Published: 2002
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The purpose of this study was to clarify the effects of synovial tissue and growth factor on the healing process of the rotator cuff in a rat model. A 3mm-diameter full thickness defect at the supraspinatous tendon was created in 48 rats. They were classified into the following 2 groups : F group with only defect, S group with defect filled with synovial tissue of the knee. The shoulder were removed at 1,2,4 and 8weeks after surgery. The specimens were investigated using H-E staining, immunostaining with anti-bodies against proliferating cell nuclear antigen (PCNA), TGF β-1, bFGF and
in situ hybridization using the cRNA probe for the procollagen types I and III. Each sample was evaluated by microscopic examination using a semiquantitative scale of histologic tendon mature grading, the percentage of positively stained cells. The data were analyzed by Mann-Whitney's U- test. On macroscopic evaluation, group S had a closure of defects at 4 weeks but group F had persistent defects of the articular side at 8 weeks. The histologic tendon mature grading and the percentage of positively stained cells of the PCNA were higher in group S than in group F throughout all periods. At 1 and 2 weeks, the histologic tendon mature score for group S was significantly higher than that for group F. Signals of procollagen types I and III for group S were detected in tissues whole around the defect area, whereas those for group F were localized in tissue adjusted to the bursal side and articular side. Expressions of bFGF were detected in tissues whole around the defect areas in both groups, whereas those of TGF β-1 were detected marked higher in group S than in group F. Our findings indicate that the synovium plays an important role in enhancing the tendon healing capacity and expressions of TGF β-1 may affect the synovial effect of the healing process for the rotator cuff.
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Jun'ichiro HAMADA, Wataru ONO, Kazuya TAMAI
2002 Volume 26 Issue 2 Pages
309-314
Published: 2002
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The purpose of this study was to identify whether the glenohumeral joint (GHj) or subacromial bursa (SAB) is the main inflamed site, and which pathway should be operated on for the degradation of the articular cartilage after a cuff tear. We obtained synovial fluid, SAB, the stump of a torn supraspinatus tendon (cuff), synovium, and articular cartilage (cartilage) from 8 patients with a complete-thickness tear. As a control, the cuff and cartilage were removed from 2 patients with tumors around the shoulders. We measured the concentration of interleukin-1 β (IL-1 β), IL-6, matrix metalloproteinase-1 (MMP-1), MMP-3. Immunohistochemical localization with antibodies to proliferative cell nuclear antigen (PCNA), IL-1 β, IL-6 and MMP-3 was performed using the ABC immunoperoxidase method. Concentrations of IL-1 β were 4.8±4.3 pg/ml, IL-6 485±4.3 pg/ml, MMP-1 417±330 ng/ml, MMP-3 6105±4258 ng/ml. A few nuclei were stained by PCNA but no cell by IL-1 β, IL-6, or MMP-3 in the control tissues. IL-1 β immunoreactivity was highest in the following order synovium, cuff, SAB, and cartilage ; for IL-6 the order was synovium, cuff, and SAB ; for MMP-3 in the order was synovium and cuff. Even though we found the same pathological findings (hyperplasia and abundant blood vessels) between the SAB and the synovium, expression of both IL-1 β and MMP-3 were much higher in the synovium than in the SAB. We conclude from these results that GHj is the main inflamed site after a cuff tear, and the extrinsic pathway is more greatly operated than the intrinsic pathway to cartilage degradation.
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Kunihiko KOBAYASHI, Tomotaka NAKAJIMA, Yoshiyasu Uchiyama, Hiroaki FUK ...
2002 Volume 26 Issue 2 Pages
315-319
Published: 2002
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We wish to evaluate the results of hemiarthroplasty for chronic 2- and 3- part fractures of the proximal humerus. Thirty-five cases of humeral hemiarthroplasty using Neer II prosthesis were performed for 2- and 3- part fractures of proximal humerus from 1986 to 1999. Twenty-one cases (chronic-group : 7, acute-group : 14) were evaluated by the Neer scoring system. At the time of injury, patient's average age was 63 y/o in chronic-group, and 59.6 y/o in acute-group. The average time elapsed from injury to surgery was 10.4 months in chronic-group, and 13.7 days in acute-group. The average follow-up period was 26.7 months in chronic-group, and 51.6 months in acute-group. The chronic-group consisted of three nonunions of 2- part surgical neck fracture and four cases following 3- part fractures (one nonunion, two malunions, one humeral head necrosis). The acute-group consisted of one 2- part anatomical neck fracture, one fracture-dislocation, nine 3- part fractures and three 3- part fracture-dislocations. In chronic-group, preoperative / postoperative Neer scores were 43.6 / 58.7 (pain : 24.3 / 30.7, function : 11.4 / 14.0, ROM : 6.4 / 8.7, and anatomy : 1.4 / 5.3). In acute-group, the postoperative Neer scores were 80.6 (pain : 32.1, function : 24.7, ROM : 15.0, and anatomy : 8.8). In acute-group, 3 patients had an excellent result, 6 patients had a satisfactory result, 4 patients had an unsatisfactory result and 1 patient had a failure result. All patients in chronic-group had a failure result. The results of chronic-group were worse than those of acute-group. However, in chronic-group, pain and external rotation were improved, compared to results of acute-group. The results of hemiarthroplasty for chronic fractures showed a significant improvement for pain, external rotation and ADL, however, these were inferior to those for acute fractures.
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Hiroyuki SHIMIZU, Moroe BEPPU, Kazuhiko MATSUSITA, Hitosi KIHARA, Hide ...
2002 Volume 26 Issue 2 Pages
321-324
Published: 2002
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The purpose of this study was to evaluate the results of hemiarthroplasty for fractures of the proximal humerus. We performed hemiarthroplasty on 28 patients from 1996 to 2000. The cases were 14 males and 14 females, with an age ranging from 34 to 94 (average of 67 years old). The mean post-operative follow- up period was 15 months. The types of fracture consisted of 2-parts fracture in 3,3-parts fractures in 8 and 4-parts fractures in 14, and 3 patients had a non union, a delayed union and a bone necrosis. We used Neer's type prosthesis in 15 cases and global type prosthesis in 13 cases. We evaluated the results by Japan Orthopaedic Association (JOA) score. The average postoperative JOA score was 70 points, ranging from 41 to 97 points. The clinical results were excellent in 4 cases, good in 2, fair in 9 and poor in 13. Six patients had no pain, but two patients had night pain. The average active elevation was above 150 degrees in only 6. The oldish patients with weak muscle, the patients with displaced greater tuberosity and the patients with axilly nerve palsy were evaluated as poor. Hemiarthroplasty provides a pain free shoulder, however recovery of the range of motion and function were limited. Anatomical reattachment of the greater tuberosity is important to gain satisfactory results.
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Naoki SUENAGA, Akio MINAMI, Hiroyuki KATO, Hiroyuki KAMISHIMA, Naomi O ...
2002 Volume 26 Issue 2 Pages
325-328
Published: 2002
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The objective of this study was to investigate the clinical results of humeral head replacement and total shoulder arthroplasty for those who have osteoarthritis of the shoulder. Since 1992, 13 shoulders in 13 patients who have osteoarthritis of the shoulder without an irreparable cuff tear have had shoulder arthroplasty performed on them. Their averaged age was 66.7 years old (range : 54 to 76 years old). Six cases had received a humeral head replacement, the other cases had total shoulder arthroplasty. Seven humeral stems and glenoid components were fixed using bone cement. All the cases were investigated using Japanese Orthopaedic Association shoulder score. The follow-up period averaged 42.7 months (range : 18-74 months). The preoperative symptoms were improved in all cases. The total and pain scores of the JOA score and the postoperative range of motion of the shoulder showed no significant differences between the two operative groups. Favorable clinical results of shoulder arthroplasty in patients with osteoarthritis of the shoulder were obtained with or without glenoid resurfacing.
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Masahiko KOMAI, Toshinori KONDO, Takashi HASHIMOTO, Jun HASHIMOTO, Kat ...
2002 Volume 26 Issue 2 Pages
329-332
Published: 2002
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The purpose of this study was to evaluate the postoperative results of shoulder arthroplasty. From 1974 to 2000 total shoulder arthroplasty and hemiarthro- plasty on 116 patients (119 shoulders) were performed. There were 40 males and 76 females. The average age was 61.5 years old. The follow-up period was 11.5 years. The operations were performed for the treatment of old fractures or fracture dislocations (71shoulders), rheumatoid arthritis (23 shoulders), osteoarthritis (22 shoulders, and others (3 shoulders). Follow-up evaluations were done with pre and postoperative range of motion (ROM), manual muscle testing (MMT) and pain. The amount of postoperative flexion averaged 118.0°, extension averaged 44.0°, abduction averaged 99.0°, external rotation averaged 29.6°, and internal rotation averaged 52.2°. The average of postoperative ROM of old fractures was the highest (flexion : 129.8°, extension : 43.7°, abduction : 110.2°, external rotation : 33.5°, internal rotation : 53.0°). The average of postoperative ROM of rheumatoid arthritis was the lowest (flexion : 105.0°, extension : 41.2°, abduction : 85.8°, external rotation : 28.5°, internal rotation : 50.4°). The amount of postoperative MMT averaged 3.2-3.6. 73.8 percents of RA and 92.5 percents of patients without RA had only slight or no pain. The purpose of a shoulder arthroplasty is decreasing pain and function reconstruction, and not a mere replacement arthroplasty on anatomization. The security of the rotator cuff function is the most important factor for a shoulder arthroplasty.
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Taiki KOMATSU, Tomoji ISHIKAWA, Naoki KATAYAMA, Yoshiteru MUTOU
2002 Volume 26 Issue 2 Pages
333-336
Published: 2002
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Swimming is generally accepted as a sport with minimal physical injuries. However, swimmers frequently complain of shoulder pain, termed ”swimmer's shoulder”, which is thought to be a form of overused disorder. We investigated the factors related to shoulder pain in a cohort of elite swimmers in an attempt to isolate causes of this disorder. The subjects include 123 swimmers selected to participate in the Japan swimming championships between 1996 and 2000. Each participant had undergone complete medical examinations at the time of their competition. A study questionnaire was employed which asked the subject to grade the severity of their shoulder pain asked whether they trained with paddles and flippers, practiced any weight training, tubing and swim bench, did any stretching, and asked them to describe the type of swimming events in which they participated. The McNemar test and chi-square test were used in the statistical analysis. The incidence of shoulder pain was higher in swimmers who used paddles and flippers (p<0.01) and pain occurred more frequently during the weight training (p<0.01). Swimmers who stretched experienced a lower incidence of shoulder pain (p<0.01). There were no significant relationships between the shoulder pain and the type of swimming events or the practice of tubing and swim bench. : The use of the paddles and flippers as a training method needs to be investigated further as this appears statistically related to the development of ”swimmer's shoulder”, a frequently cited overuse disorder among the swimming population. Furthermore, the practice of performing stretching exercises appears to prevent shoulder pain in this population and should be included, as part of the warm-up routine.
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Naoya NISHINAKA, Hiroaki TSUTSUI, Kenichi MIHARA, Shigeru HOKARI, Kazu ...
2002 Volume 26 Issue 2 Pages
337-340
Published: 2002
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Many top golfers have limited pronation or hip adduction when their swing is unstable. We suspected these limitations could be the cause of an unstable swing. To clarify this relation, we made a limited model by taping and the swing was analyzed. A professional female golfer, with a stable swing swung a driver. A stick-figure was made. The angular velocity both of the hip and the shoulder, the linear velocity of both of the wrist and the club head during the swing were analyzed by a three-dimensional motion analyzing system. The parameters were compared with those when her pronation or hip adduction was restricted by taping. In a normal swing, the forward swing started in order of the hip, the shoulder and the wrist joint. The maximum velocity appeared in order of the hip, the shoulder and the wrist. The velocity of these joints decreased just before the impact. The club head speed was maximum just at the impact. In the restricted swing, the angular velocity of the shoulder became maximum earlier than that of the hip joint, moreover the angular velocity of the hip joint became faster than that of the shoulder joint. A change in the kinetic chain was seen. In an ideal swing, motion appeared from proximally to distally. The results infer that the limitation of ROM could be a cause of unstable swing and reducing the limitation could improve the swing.
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—A Combination of Modified Bristow Procedure and Capsular Shift—
Koutaro SHINMURA, Katsumi TAKASE, Takahito HOTTA, Atsuhiro IMAKIIRE
2002 Volume 26 Issue 2 Pages
341-345
Published: 2002
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[Purpose] Variable surgical procedures were performed on patients with a recurrent anterior dislocation of the shoulder. We performed a combination of modified Bristow procedure and capsular shift on twenty-three athletes engaged in contact sports. This report is a review of these patients.
[Materials and Methods] The subjects ranged in age from sixteen to twenty-five years old. We evaluated the therapeutic results more than two years post-operatively. These results were evaluated based on the Rowe's criteria.
[Results] All the patients could return to their contact sports that they had been engaged in before injury, but five patients were unable to return to their preinjury levels of athletic participation. Concerning the joint stability, only one patient had recurrent instability while playing contact sports, and no patients had a recurrence of dislocation. Fifteen degrees or greater limitation of external rotation with the arm at side was observed in eleven patients and the average limitation was 15.8 degrees. Complications related to hardware problems were observed in two patients, and one patient had a nonunion transferred coracoid process.
[Conclusion] The returning to contact sports was satisfactory after a combination of modified Bristow procedure and capsular shift. However, some athletes engaged in contact sports need a sufficient range of motion after their operations. Therefore, more careful selection of candidates for this procedure should be considered.
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Kiyoshi SAKAI
2002 Volume 26 Issue 2 Pages
347-349
Published: 2002
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We evaluated whether a mini-open cuff repair with arthroscopic subacromial decompression could reduce the postoperative pain more than open cuff repair. We compared the data of two groups ; mini-open cuff repair with arthroscopic subacromial decompression (ASD) and open cuff repair so called McLaughlin's procedure. We researched the preoperative shoulder score assessed by the Japanese Orthopedic Association, the operation time, and the amount of bleeding. We also researched the following items from the day at operation to 7th day as markers of the postoperative pain ; dose of analgesic agents (pentazocine and diclofenac sodium), visual analogue scale, and face scale both evaluated by nurses, respectively. From January in 1998 to March 2001, a mini-open cuff repair with ASD was performed in 13 cases and an open repair was in 20 cases. The dose of pentazocine was lower in the mini-open cuff repair with ASD group than in open cuff repair cases in statistical significance. The dose of diclofenac sodium also tended to be lower in the mini-open cuff repair with ASD group. The time of the operation was definitely longer in the mini-open repair with ASD cases than in open surgery. The other items showed no differences between these two groups. In this series, a mini-open cuff repair with ASD is more time consuming, but it reduces postoperative pain more.
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Keisuke MATSUKI, Hiroyuki SUGAYA, Akihiro TSUCHIYA, Takeyuki OKAZAKI, ...
2002 Volume 26 Issue 2 Pages
351-355
Published: 2002
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The purpose of this study was to analyze the characteristics of redislocation/subluxation cases after arthroscopic Bankart repair using suture anchors through the findings during revision arthroscopic surgery and three-dimensional computed tomography (3DCT) of the glenoid. Thirteen out of 150 shoulders experienced redislocation/subluxation. All of them had resumed their former sports levels and were reinjured during a sports activity. The average age at the time of reinjury was 19.2 (range, 15-28) years old and the average period from the initial surgery was 9.2 (range, 2-22) months. Twelve out of 13 shoulders were reinjured less than 13 months from the initial surgery and 4 shoulders less than 6 months. 3DCT of the glenoid revealed poorer morphology of the antero-inferior part of the glenoid rim in 10 out of 11 shoulders, including acute glenoid rim fracture in 4 shoulders, compared with the 3DCT performed prior to initial surgery. Suture breakage without knot/anchor failure was observed in every shoulder during revision arthroscopic surgery performed in 8 shoulders. In 4 acute glenoid rim fracture cases, the reconstructed labro-ligamentous complex during initial surgery was firmly attached to the bony fragment. We conclude that it is important to obtain initial strength by suture augmentation and to retain glenoid rim morphology by ”bony Bankart repair” in cases of bone defect during initial surgery, especially in high-demand athletes. In high risk cases such as poor glenoid morphology, arthroscopic rotator interval closure is recommended in addition to the intra-articular anatomical repairs.
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—Evaluation by MRIs—
Tomonobu HOTTA, Yoichi SAITO, Takayuki CHIBA, Hidenori YAMAMOTO
2002 Volume 26 Issue 2 Pages
357-361
Published: 2002
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The purpose of this study was to evaluate the natural history of partial rotator cuff tears, especially a bursal side tear. 22 cases which were clinically diagnosed to have bursal side partial rotator cuff tears and had undergone MRIs twice. The average age of the patients was 68 years old, ranging from 42 to 86 years old. T2 weighted images were obtained along the oblique coronal plane and we evaluated the changes of high intensity in the rotator cuff in MRI. We compared the group with an enlargement of the tear size and the no-enlargement in age, sex, activity, dominant hand, smoking, and the shape of the acromion. Eleven cases (50%) showed an enlargement of high intensity. There was no correlation between the follow-up period and the enlargement size. Seven cases (32%) had become complete rotator cuff tears. There are no statistical differences between the enlargement and no-enlargement groups. This study showed that bursal side partial rotator cuff tears can enlarge in many cases.
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Tetsuya NAKATANI, Hiroshige SAKAI, Yasunobu IWASAKI, Kenji FUJITA
2002 Volume 26 Issue 2 Pages
363-367
Published: 2002
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We reported on two cases of rotator cuff tear in which the signal of the rotator cuff in T2 weighted MRI was not high on the first try, but turned to be high on the second try taken a few months later. (Case 1) A 27-year-old man with left shoulder pain after a fall in a soccer game, was seen in our clinic 7days after injury. No high signal area in the supraspinotus tendon in T2 weighted MRI was seen on the first try, but high signal area was seen on the second try taken two months later. A mini open cuff repair was undertaken and a 5mm x 5mm intratendinous tear communicating with the joint was found. (Case 2) A 68-year-old man with left shoulder pain after a fall had weakness in the supraspinatus. No high signal area in the supraspinotus tendon in T2 weighted MRI was seen on the first try, but turned to be high three months later. Open cuff repair was undertaken and 3cm x 4cm full thickness tear involving an intratendinous tear was found at the operation. Many authors have reported about the correlation between MRIs and the operative findings of a rotator cuff tear. However, there have been no reports concerning whether a false negative would change to a positive or stay negative. We reported two cases in which the MRI signal of rotator cuff changed within a few months without any new traumatic episodes and each case had an intratendinous tear. These cases indicate that an intratendinous tear occurs first, develops to a bursal side or articular side tear and advances to a full thickness tear. These findings suggest that MRIs should be taken several times for patients with continuous clinical symptoms and signs of a rotator cuff tear.
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Yoshinori TAKUBO, Motoyuki HORII, Masao KUROKAWA
2002 Volume 26 Issue 2 Pages
369-372
Published: 2002
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We investigated the utility of MR imaging of the shoulders in abduction and external rotation position (ABER method) for evaluating the labrum and anterior inferior glenohumeral ligament (AIGHL) after arthroscopic surgery. Eight shoulders of 8 patients (age ranged from 21 to 49 years old, average 31 years old) who had passed more than three months after arthroscopic Bankart repair and underwent ABER method were examined. According to our method reported previously, the ABER method was performed three, six and twelve months after surgery. The labrum and AIGHL were evaluated. It was impossible to judge the labrum with a metal artifact in one shoulder : two images, and with a motion artifact in one shoulder : one image. It was possible to evaluate the labrum in 81% (13/16 images). Before surgery, Group A (with a well delineated anterior capsule) was six shoulders. Three months later, four shoulders had not changed. Two shoulders demonstrated Group B (without a well delineated anterior capsule), however showed a low signal intensity (Group A) six months later. Before surgery, two shoulders had been Group B, they still were Group B three months later, however then demonstrated Group A symptoms six months after that. We were able to evaluate the postoperative condition of arthroscopic surgery using the ABER method. Three months after surgery, the high signal intensity of the reconstructed ligament remained, however six months later it demonstrated a low signal intensity, thereby it was speculated that it would change into a thick and wide ligament after arthroscopic reconstruction.
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Katsumi TAKASE, Koutarou SHINMURA, Kengo YAMAMOTO, Atsuhiro IMAKIIRE, ...
2002 Volume 26 Issue 2 Pages
373-378
Published: 2002
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Accurate reproduction of anatomic relationship is important in non-constrained prosthetic arthroplasty. However, the geometry of the glenohumeral joint for prosthetic components has not been established yet. In this study, we evaluated the relationship between the position of the greater tuberosity and various geometric measurement values in the glenohumeral joint. Radiographs of 519 shoulders without osseous lesions were reviewed. There were 296 males and 223 females, and the mean age was 49.7 years old. Four parameters were measured on true anteroposterior radiographs, including the distance between the greater tuberosity and the humeral head, and the neck shaft angle. There were significant differences in all parameters between the males and females. Especially, the distance between the greater tuberosity and the humeral head was significantly correlated with the neck shaft angle in both the males (P<0.01, r=-0.468) and females (P<0.01, r=-0.639). At replacement of the smaller neck shaft angle than the anatomical neck shaft angle observed in the patient, the replacement of the humeral head component in the same distance between the greater tuberosity and the humeral head as that before surgery, might not be considered to be the reproduction of the anatomical glenohumeral joint. Therefore, we concluded that the determination of the distance between the greater tuberosity and the humeral head, in consideration of its relationship with the neck shaft angle, is important for the prevention of postoperative subacromial impingement.
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Yoshiyuki NAKAGAWA, Takamitsu MONDORI, Munehiro OGAWA
2002 Volume 26 Issue 2 Pages
379-382
Published: 2002
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The purpose of this report was to clarify the pathogeresis of the primary osteoarthritis (OA) of the shoulder. OA of the shoulder is characterized by osteophyte, sclerosis, irregularity and narrowing in the glenohumeral joint, which has no traum and the wide acromio-humeral interval (AHI) (AHI≥5mm). For research of the polyarticular OA, elbows, wrists, fingers and knees werw examined radiologically.
Chondrocalcinosis (CC) is characterized by the calcific deposite in the meniscus of the knee. Patients were composed of 30 cases 46 shoulders (both side 16 cases, right side 5 cases, left side 9 cases). One case was male and 29 cases were females. Their average age was 79.2.
Radiologically, OA of the shoulder was divided into 2 types. Smooth type (29 shoulders) showed a smooth subchondral bone of the humeral head. Irregular type (17 shoulders) showed an irregular subchondral bone of the humeral head. In the elbow or wrist joints, 6 cases (32%) of 19 cases were associated with OA. In the finger joints, 9 cases (43%) of 21 cases were associated with OA. In the knee joints, 16 cases (70%) of 23 cases were associated with OA. Most of cases had polyarticular OA. On the other hand, 5 cases (22%) of 23 cases had OA only in the shoulder joint. Eight cases (32%) of 25 cases were associated with CC.
It is possible that OA of the shoulder is not caused by overuse of the upper extremities, but caused by constitutional disease. Most OAs of the shoulder have some relationship to polyarticular OA. a minority group may have a different pathogenesis from polyarticular OA.
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Toshihisa OHSAWA, Takashi ISIKAWA, Masayuki ARAMAKI, Hideki SUZUKI, Sa ...
2002 Volume 26 Issue 2 Pages
383-387
Published: 2002
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The purpose of this study was to compare the findings of CT arthrography (CTA) with arthroscopic findings in recurrent anterior instability of the shoulder. In 26 patients, preoperative CTAs and arthroscopy (A/S) were performed. Attachment of the anterior joint capsule in the normal side were classified into 3 types : attachment to the labrum (15 shoulders), to under the labrum (7), to the base of the glenoid (4). It was difficult to define the labrums of Bankart's lesion by CTA. It was interesting that 7 patients had an attachment to under their labrum in their normal sides, 5 of them had a labrum adhesion to the glenoid necks on A/S.
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Kenji HAYASHIDA, Shigeto NAKAGAWA, Yukiyoshi TORITSUKA, Takashi MIYAMO ...
2002 Volume 26 Issue 2 Pages
389-392
Published: 2002
Released on J-STAGE: January 18, 2008
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We examined the factors related to shoulder pain of baseball players. We examined 569 pitchers who were qualified to participate in the national inter high school baseball tournament in Japan before games and reviewed them retrospectively. The items examined were experience of shoulder pain continued more than a month in throwing, range of motion (ROM), abduction power, acromion shape, great tuberosity (GT) shape, inferior and posterior shift by stress X-ray, and Bennett's lesion. The items related to the shoulder pain history were analyzed statistically. A hundred forty-seven pitchers of 569 (26%), who experienced shoulder pain continued more than a month, were classified into the pain group and the others were classified into the no pain group. The items related to the shoulder pain history were the GT shape and inferior shift. Players who experienced shoulder pain tended to have angle shaped GTs, and players who did not experience shoulder pain tended to have a positive inferior shift. ROM, abduction power, acromion shape, posterior shift, and Bennett lesion were not related to shoulder pain history. Players who have an angle shaped GT experienced shoulder pain more frequently, and players who have an inferior shift experienced pain less frequently.
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Toshinori KONDO, Jun HASHIMOTO, Takashi HASHIMOTO, Masahiko KOMAI, Kat ...
2002 Volume 26 Issue 2 Pages
393-397
Published: 2002
Released on J-STAGE: January 18, 2008
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The purpose of this study was to examine the arthrographic findings of injuries of the infraspinatus tendon (ISP) and to evaluate the change of the lesion from the plural findings. 171 shoulders (ranging from 14 to 40 years of age) were examined, who were suspected injury of an ISP. The majority were caused by the sport like baseball (75.4 %), and followed by volleyball and handball. The painful phase and the physical findings were analyzed. The latter consisted of tenderness on the ISP, muscle atrophy of the ISP and latissimus dorsi muscle stiffness. The injury of the ISP were also examined by arthrography. The findings of the injury were classified into three groups. Grades 1, 2, and 3 were defined as intact, pooling, and torn type respectively. We evaluated the relationship between the classification and the antero-posterior instability, the slipping phenomenon and the existence of the posterolateral notch like lesion of the humeral head. Forty-seven who had a renovated state of ISP were also evaluated arthrographically. Grades 1,2, and 3 were 17.0, 46.8, and 36.2% respectively. The degree of the ISP injury tends to be associated with instability. There was a relationship between an ISP injury and a postero-lateral notch like lesion. Although there was a renovating tendency of the ISP injury arthrographically (48.9%), these findings did not improve in some cases. However, they had less pain clinically and recovered their sports activity by proper treatment. The injury of a ISP is related to functional instability in sports activities and the pathogenesis can be suspected from the physical and roentgenographic findings. An injured ISP seems to have the possibility of natural healing.
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Takayuki MATSUHISA, Hiroaki TSUTSUI, Kenichi MIHARA, Shigeru HOKARI, K ...
2002 Volume 26 Issue 2 Pages
399-403
Published: 2002
Released on J-STAGE: January 18, 2008
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For the baseball player who has some symptoms in the shoulder, there are a lot of cases admitting a functional problem in the hip joint and the trunk. The relationship between the limited range of motion of the hip joint and the trunk and the throwing are examined with a motion analyzer. Three baseball players were studied at medical checkup. The subjects were filmed pitching from four directions. The velocity of the shoulder, elbow, wrist, hip and knee joint on the throw side calculated using a motion analyzer (Peak co.). In addition, they were studied on two cases ; the restriction of adduction of the hip joint and rotation of the trunk with bandages. Two cases had shown a maximum velocity in order of the hip joint, the shoulder, the elbow, and the wrist joint immediately before release of the ball. However, when they were restricted adduction of the hip joint, the reverse phenomenon, which was that the shoulder showed a maximum velocity after, the elbow had begun deceleration, was seen. Similar results were seen when they were restricted rotations of the trunk. When adduction of the hip and rotation of the trunk was artificially restricted, the change in the kinetic chain was seen, especially the reversal phenomenon of the shoulder and the elbow was seen.
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Satoshi MAEDA, Junji IDE, Katsumasa TAKAGI
2002 Volume 26 Issue 2 Pages
405-407
Published: 2002
Released on J-STAGE: January 18, 2008
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MR arthrography has been performed for the injured shoulders in athletes in our institution. MR arthrograms were compared with arthroscopic findings to report its diagnostic significance and efficiency. Between July 1999 and December 2000, MR arthrography and arthroscopic evaluations of the shoulders were performed in 26 athletes, 20 men and 6 women with a mean age of 22.2 years old (range from 14 to 39). Preoperative diagnoses were 11 superior labral injuries, 10 anterior labral injuries, etc. 10 ml contrast medium and 5 ml lidocaine with Gd-DTPA of 250-fold dilution were used for this study. In the 10 shoulders with Bankart lesions diagnosed in MR arthrograms preoperatively, all cases were confirmed to have the lesions arthroscopically. There were no cases with a false positive nor a false negative. The sensitivity, specificity, and accuracy of this maneuver for Bankart lesions were all 100 %. In the 11 shoulders which were diagnosed type II SLAP lesions by MR arthrography, the lesions of 10 shoulders were found arthroscopically. There was only one case of false positive and no cases of false negative. The sensitivity, specificity, and accuracy of this maneuver for type II SLAP lesions were 100 %, 93.8 %, and 96.2 %, respectively. MR arthrography was useful to diagnose labral tears of the injured shoulders in athletes.
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