The aim of this study was to devise a measurement method for the shoulder internal rotation with the elbow being extended using special plates that we developed, and compared the measured angles with those of conventional measurements. The subjects were 20 healthy volunteers (40 shoulders). In our new method, a rod was applied to the front of the elbow, and the internal rotation angles were measured using the plates with the elbow being extended, As the conventional method, internal rotation was expressed as thumb-distance from Jacoby's line. In addition, the external rotation angles were measured conventionally with the elbow flexed. Measurements were taken 3 times, each in the unit of 5 degrees or 1 cm in the sitting position. The angle of internal rotation was 80-120°in the new method and 17-41cm in the conventional method; there was a correlation (p<0.001), with a correlation coefficient of O.645. The differences of the values in the three times measurements were 0°(no difference) in 19 shoulders and 5°in 21 shoulders in the new measurement of the internal rotation. In the conventional measurement of the external rotation, tie difference was 0°,5°and 10°in 22,17 and 1 shoulder, respectively. The measurement of the shoulder internal rotation with elbow extended was easy to achieve, and the differences of the values in the three times measurements were almost identical with those of the conventional measurement of the shoulder external rotation. The new method is useful for measuring the range of internal shoulder rotation.
The purpose of this study was to compare the humeral retroversion measured using a CT with that using a radiogram. We analyzed twenty healthy volunteers (forty humeri). Ten were male and ten were female. We adopted two measuring methods using the CT to draw the humeral head axis; Simeonides' Method (Method S)and our original method (Method A). The cubital axis was drawn as the tangent to the epicondyles. We also adopted a modified Soderlund's Method in the measurement using a radiogram. In his original method, it is impossible to measure the humeral retroversion because we can not define the edge of the articular surface of the humerus. The retroversion angle using Method S was 34.8 ± 12.9°, and using Method A was 32.6 ± 10.7°. The result of the measurement based radiogram was 28.9 ± 10.6°. The mean value of the retroversion measured using CT was larger than that of using a radiogram. There was a significant difference of the mean value of the retroversion between the result of the measurement using CT and radiogram. The difference of the humeral retroversion between Method S and A was not significant. We also analyzed the humeral retroversion in 10,15,20, and 30 of abduction of the shoulder joint with the radiogram based method. The retroversion angle tended to decrease gradually with the increase of the abduction angle. The results of this study were different from Soderlund's report.
The purpose of this study was to investigate the airborne microorganisms in environments where shoulder arthrographies are performed. Using an air sampler assembly we measured the bacterial count of airborne microorganisms in an imaging room, a general operating room and a bioclean operating room (OR). The measurement method attracted air at 1601/4min to a nutrient medium and cultured it. The bacterial number in lft3 was then measured. The bacterial numbers were 2.94 ±0.83CFU/ft3 in the imaging room while not in use and 31.25 ± 2.14CFU/ft3 in the imaging room while in use. They were 13.90 ± 1.81 CFU/ft3 in the OR while not in use and 25.91 ± 3.64 CFU/ft3 in the OR while in use. They were 0.11 ± 0.04CFU/ft3 in the bioclean OR. According to a questionnaire study regarding complications from arthrography (Hugo etc), the infection number was reported as twenty-nine cases among 262,000 arthrographic procedures, but data about specific cases where injected air was used were unknown. We demonstrated that the number of airborne microorganisms were large quantities and the kinds of bacteria were various in the environment where shoulder arthrography is performed. According to our results, we were unable to deny the likelihood of incidence of septic arthritis at the time of arthrogram examination when injected room air was used, depending on the conditions of the collected air itself. These results suggested that when injected air was used in a joint as a contrast medium negative, it was necessary to consider carefully the conditions of the collected air.
The aim of this study was to examine the histopathologic changes of the rotator interval (RI) region in cases of frozen shoulder (FS), RI lesion, and other shoulder diseases. Twenty-five RI tissues were obtained from 25shoulders during surgery. There were 5 recurrent dislocations of the shoulder,10 Type II RI lesions,2 Type I RI lesions,5 FS and 2 rotator cuff tear cases. A biopsy was taken of the coracohumeral ligament (CHL) and the capsule of the RI. All specimens were examined histochemically and immunohistochemically. The surgical findings in cases with FS showed that the CHL was contracted and coalesced with the supraspinatus tendon and the RI was replaced by a scar-like tissue. Histopathologic examinations of the CHL and scar-like tissue in FS revealed fibrosis with an active myofibroblastic proliferation. No remarkable inflammatory reaction was observed. The tissues from an RI lesion and other cases without contracture demonstrated mild synovial proliferation with reactive vascular proliferation. The difference of the reactivity of the myofibroblast against the microtrauma in the RI region might result in contracture or instability of the shoulder.
The purpose of this study was to evaluate the usefulness of measuring quantitatively the anterior joint volume in shoulders with traumatic anterior instability using 3DCT. The subjects consisted of 73 shoulders, under 40years old, in which pre-operative CT double contrast evaluation was revealed. There were 56 male and 17female subjects, with an average age of 22 years old (14-35). In supine position and the affected arm in neutral rotation,1cc of contrast agent and 20 cc of air were injected and a 3DCT image was taken. All 3DCT images used were taken with a Lemage Supreme equipment (single detector-row, collimation: 3mm, rotation speed: 1.0s/revolution). The reconstruction images of 3DCT were analyzed using an Advantage Workstation 2.0. First, with the threshold set at -1024∼-600, the 3DCT image of air was reconstructed by 1/2 pitch. Then the general glenohumeral joint volume was estimated using an air image. Next, from the maximum intensity projection image, the central line between the superior edge and inferior edge of the glenoid; from the axial image, the line parallel to the glenoid; and finally from the reconstructed sagittal image, the line that runs from 12- 6 o'clock on the glenoid rim were calculated. Using these 2 planes, the anterior superior and anterior inferior glenohumeral volumes were measured and compared to the entire glenohumeral joint volume. The average rates of anterior superior and anterior inferior volume were 18.2 ± 6.2% (7.7-32.6) and 35.7 ± 7.9% (21.0-48.4). The difference in volume between the anterior superior and anterior inferior was statistically significant (p<0.001). The results of this study revealed that an anterior joint cavity expands in an inferior direction in shoulders with a traumatic anterior instability. The measurement of the shoulder volume was a valuable method of estimating the enlargement of the capsule.
The purpose of this study was to describe the clinical results of acromioclavicular (AC) joint reconstruction. The charts of 196 patients who underwent AC joint reconstruction were reviewed retrospectively. They were classified into 3 types as described by Tossy. Demographic data, pre & postop clinical findings were described. The site of screw insertion and sternoclavicular angle (SCA) were noted on x-rays. The average age of patients was 37.9 years old with an average follow-up of 9.6 months.6 in Type I,8 in Type II & 154 in Type III. At follow-up 82.7% (139) had good to excellent results while 17.3% had slight dysfunction and persistent pain. Of the 196 patients 168 underwent a Dewar procedure while 5 underwent pinning of the AC joint and 23 had resection done. In the good to excellent group, x-rays showed the screw was at the conoid tubercle of the clavicle in 84.2%of 139 patients while in 17.2% the screw was not and belong to the group with poor results. The SCA increased by an average of 7.8 in the former but only 4.1 in the latter. The success rate of AC joint reconstruction was 82.7% using the Dewar procedure. Screw placement and SCA were related to a good outcome.
The purpose of this study was to reveal the prevalence of the so-called inverted-pear glenoid with or without associated bony fragment. According to previous literature, a majority of the inverted-pear glenoid, which is defined as more than 25% to 27% defect of the glenoid width, is not associated with a bony fragment and, therefore, open bone grafting is indicated. However. Sugaya introduced arthroscopic bony reconstruction in patients with a large glenoid defect associated with a bony fragment and reported excellent outcomes. A consecutive series of 121 shoulders, including 97 males and 24 females with an average age of 24 years (range,13-54), were evaluated using 3DCT with the humeral head-eliminated preoperatively. Bone loss was determined as a ratio of defect width against the diameter of the assumed circle based on the inferior portion of each glenoid. The prevalence of the inverted-pear glenoid was investigated when the defect rate was set at more than 25% and more than 30% defect. There were 58 bony Bankarts and 55 erosions with an average defect rate of 21.6% (range,9.1-43.8) and 11.4% (range,2.7-27.8), respectively. Nine-teen glenoids (15.7%) were measured as more than 25% defect with an average defect rate of 30.2% (range,25.0-43.8). A bony fragment was confirmed in 18 out of 19 shoulders (94.7%) in this group. On the other hand,9 glenoids (7.4%) were measured as more than 30% defect with an average defect rate of 35.6% (range,30.6-43.8). A bony fragment was confirmed in all shoulders in this group. In conclusion, a majority of shoulders with a large glenoid defect are associated with a bony fragment as evaluated by 3DCT.
The purpose of this study was to analyze relevant factors in recurrent anterior glenohumeral instability associated with an anteroinferior capsular tear. Twenty-seven shoulders (13 women,14 men) with the capsular tear identified during arthroscopic stabilization were retrospectively reviewed. The average age at surgery was 29.5(range,16-63) years old. We analyzed the average age at the initial dislocation, frequency of dislocation, and 3DCT of the anterior glenoid in each case. The average age at the initial dislocation was 23.9(range,12-55) years old. Ten patients underwent surgeryy over 3 months after the latest dislocation. The location of the tear was classified into 3 types: glenoid-side for 16 patients, glenoid to mid-portion for 7 patients, HAGL for 4 patients. Eight patients with more than forty years of age experienced the latest dislocation after more than five years of the second latest one. We believe that the capsular tear should be repaired surgically together with other intraarticular lesions because it seems they do not to heal naturally and could be an essential lesion. In addition, we believe that the most common pathology of recurrent anterior shoulder dislocation is Bankart lesion but sometimes changes to a capsular tear.
The purpose of this study was to evaluate Bankart lesion on MR arthrographies (MRA) at pre and post arthroscopic Bankart repair.23 patients with traumatic shoulder instability who had undergone arthroscopic Bankart repair were studied. There were 24 men and 3 women (ave.24.6 y. o). The minimal follow-up period was 1-year. The labral height (LH), glenoid depth (GD), and balance stability angle (BSA) were measured on 2slices at axial images of MRA. One slice passed through the center of the glenoid and another passed the inferior quarter of the glenoid. As clinical evaluations, the existence of re-dislocations were assessed at 1year after the surgery. A re-dislocation was recognized in 3patients. After the surgery, LH, GD, and BSA were significantly improved both center-slice and inferior-slice.
Teenagers have a high risk of recurrent anterior dislocation of the shoulder. We treated teenage patients using an immobilization with external rotation position in order to protect against recurrent dislocation. We observed their stability and the improvement of damaged labrums after immobilization using MRA and Fulcrum Test. Subjects consisted of 13 cases, averaging 16.1 years of the age (13-19), who were diagnosed to have labrum injuries via a MRI exam. Subjects were immobilized at a 30 degrees external rotation position and for 4 weeks and were observed for over one year. After completion of this immobilization, we performed a MRA to confirm the repair of the labrum, and continued to check their stability using the fulcrum test until it showed negative, as well as checked patients symptoms. All anterior and inferior labrums were repaired or united with the glenoid. No cases showed leakage into repaired anterior and inferior parts of labrums. However, anterior superior labrums were not repaired. Fulcrum test proved positive at the 4 weeks after immobilization. But, it gradually turned negative by 5.8 weeks. Patients could return to sports at an average of 10.7 weeks. Their Rowe's scores were excellent. Injured anterior inferior labrums were united with the glenoids after this immobilization. Furthermore, a sling was needed for 2 additional weeks after the end of the immobilization. This method is very useful for teenage labrum injured cases.
The purpose of this study was to report on the Clinical results of modified Boytchev procedure(MBP) and arthroscopic Bankart repair(ABR). Each procedure was performed on 27 patients respectively. The minimal followed-up period was 12 months. The average followed-up period was 21 and 15 months, respectively. The age, time of surgery, dose of analgesic, period of hospitalization and clinical results were studied. The average age of the patients who were performed MBP was 24.3 years old, and 24.6 year old in the ABR. The time of surgery of MBP(99.2 minutes) was statistically shorter than that in ABR(147 minutes). Injections of analgesics were averaged 0.8 amples in MBP and 0.2 amples in ABR, analgesic suppos were averaged 1.6 pieces in MBP and 0.6 pieces in ABR. The latter were statistically higher than the former in both analgesics. Periods of hospitalization of MBP(30.6 days) were statistically longer than one of ABR(16.4 days). Elevations were 168degrees in MBP and 166 degrees in ABR, External rotations of the arm at side were 63.6 degrees and 64.2degrees, internal rotations were Th8.5 and Th9.4, horizontal external rotations were 93 degrees and 99.7degrees, horizontal internal rotation was 62 degrees and 67 degrees respectively. Statistical significances were not seen in the range of motion between the two procedures. In postoperative pain and periods of hospitalization, the ABR was statistically lower than those of the MBP. The MBP was suited to diagnostic the related group of prospective payment systems.
Seventeen shoulders of 17 patients with reoperation of recurrent anterior shoulder dislocation were examined, and the causes of the postoperative recurrence were analyzed. The initial surgical procedures were Bankart's repair in 8 shoulders, inf. capsular shift with Bankart's repair in 1, Bristow's with Bankart's repair in 1, Bristow's in 2, Boytchev's in 2, Oudard in 1, Putti-Platt in one, and Magnuson in one. The postoperative redislocation occurred at an average of 2.5 years after the initial surgery. In 10 shoulders (59%), the redislocation was cased by a traumatic event. At reoperation, the findings were a detached labrum in 16 shoulders (94%), a capsular tear in the remaining one, and the bone defect in 17 (100%), which were more than 20% in 7. Failed procedure was found in 8 shoulders, which were 3 Bankart repairs, an inf. capsular shift,3 Bristow, and an Oudard. Statistical analysis of the surgical procedures were the period, the traumatic event, the degrees of bone defect, and the failed procedure. A significant factor hastening redislocation and related to redislocation without a traumatic event was not found. The only significant fact (p<0.05) is that 8 Bankart repairs had larger bone defects than the remaining 9 surgical procedures. In the cause of a postoperative recurrence, Bankart's procedure was indicated independently in a case with a large bone defect. Preoperative precise evaluation of the pathology and the selection of an effective surgical procedure to its pathology are needed for restraint of a postoperative recurrence.
Intramedullary nailing has become widely accepted method of internal fixation of humeral fracture. No report was documented about shoulder arthrosis followed by antegrade naling. In this report, we presented two cases who had arthritic changes of the shoulder in a short period after antegrade interlocking nailing. There was the possibility of shoulder arthrosis as a complication of antegrade nailing.
We experienced 6 cases of proximal humeral fractures. We reviewed the facts on what fracture form the conventional classification method could support. The 5 classifications (Codman, Neer, Jakob, AO and Tamai classification) were used. In the Codman classification, we defined the type's number clockwise from upward left. Dividing the proximal end of the humerus into four segments, there were 14 patterns of the fracture. Then, the five conventional classifications were re-classified by these 14 fracture patterns. Cases 1 and 2 classified into type 3 by Codman's system and group 2 by Tamai's. There was not equivalent to the type of Neer classification. Case 1 did not apply and only case 2 fitted into Jakob's classification, because the type C2.1 was an impacted fracture. Oppositely, in the AO classification, only case 1 fitted the type C3.2 because it was a fracture with a dislocation. Cases 3 and 4 were not equivalent to Neer's, Jakob's or AO classifications. They were classified into group 3 in Tamai's system and type 15 in Codman's. Case 5 was classified into the B3.1 in the AO system and type 6 in Codman's. Case 6 corresponded only to a type 14 in Codman's classification. Because it was difficult to judge whether a fracture had occurred or not and to measure the degrees of transfer of the fracture, the reproducibility of the classification sometimes became a problem. Moreover, if no classification type was adequate for a fracture pattern, the fracture could not be consequently classified. Therefore, we were confident that the classification method should contain all fracture patterns.
The purpose of this study was to evaluate the osteosynthesis of proximal humeral fractures with a Polarus nail. Twenty-five patients with 2- and 3-part proximal humeral fractures were underwent osteosynthesis using Polarus nails.7 were males and 18 were females and the average age was 68 years old. The average follow-up period was 11 months. The results were evaluated based on the JOA shoulder score. The radiograph of the shoulder with maximum abduction was taken and the angle between the humeral shaft and glenoid (G-H angle)and the angle between the humeral shaft and vertical line to the floor (A angle) were measured. The ratio of the G-H angle to the A angle was calculated. All fractures were healed. The average postoperative JOA score was 84 points. The mean JOA pain score was 28 points and the mean JOA elevation score was 11 points. The mean abduction was 119 degrees. The mean G-H angle was 80 degrees. The mean A angle was 129 degrees. The ratio of G-H angle to A angle was 67%. Polarus nails for proximal humeral fracture lead to good results after an operation.
We investigated the usefulness and problems of Polarus humeral nails for proximal humeral fractures. We studied 15 patients who were operated on using Polarus humeral nails for proximal humeral fractures between 2001 and 2003. They consisted of 3 males and 12 females aged from 46 to 89 years old ( mean 66 ). The fracture type was a 2-part fracture in 11 patients, a 3-part fracture in 2 and a 4-part fracture in 2. The follow-up period ranged from 6 to 29 months ( mean 16 ). We investigated the bony union, the postoperative JOA score, and range of motion of the shoulder joint. All the patients who underwent osteosynthesis obtained a bony union, but no osteonecrosis of the humeral head. The postoperative JOA score was a mean 87 pts in a 2-part fracture, a mean 85.5 pts in a 3-part, and a mean 86 pts in a 4-part. The postoperative range of motion of the shoulder joint was a mean 116 degrees in elevation with a 2-part fracture, a mean 118 degrees with a 3-part and a mean 118degrees with a 4-part. Polarus humeral nails were useful for treatment of humeral fractures, but some problems in the system need to be solved.
The purposes of this study were 1) to compare the holding ability of two kinds of plate and screw fixation models in flexion-extension, and 2) to investigate whether the fracture stability differs on rotation of the humerus in elevation. Paired humeri from twelve embalmed cadavers were harvested. Two part proximal fractures were created with an oscillating saw. A Locking Humerus Spoon Plate (LHSP) was applied with either conventional screws or a combination of conventional screws and a locking screw in the most proximal hole. Strain gauges applied acrossthe 1mm gap detected the displacement of the fracture. Continuous signals from the gauges were recorded on a personal computer. Prepared humeri were clamped into a custom-made mechanical testing device that rotated the longitudinal axis of the humerus around the humeral head to simulate flexion-extension motion. Each humerus could be positioned independently for internal rotation with the humeral elevation parallel to the plane of the plate, or external rotation (~15 degrees) with the humeral elevation perpendicular to the plane of the plate. Such independent positioning was done in 3 pairs with a locking screw model, and in another 3 pairs with a conventional model. Both models were directly compared within pairs on right or left humeri in the internal rotation position (n=3 pairs), and the external rotation position (n=3 pairs). The locking screw model resisted failure under cyclic loading better than the conventional screw model. Both models resisted failure better on elevation at the internal rotation position than on elevation at the external rotation. Although this preliminary study was small, the results warranted further study to ascertain their clinical relevance to loss of reduction on elevation at external rotation in proximal humeral fractures.
The present study investigated whether vascular endothelial growth factor (VEGF) was involved in the development of shoulder contracture in diabetics with rotator cuff disease, comparing specimens from the subacromial bursa (SAB) and the glenohumeral joint (GHJ) near the rotator interval (RI). We examined 44patients with rotator cuff disease. The patients were divided into 11 type II diabetics and 33 non-diabetics. Expression of the VEGF gene was evaluated by using the RT-PCR. VEGF mRNA expression and synovial proliferation were more common in RI (41/44,36/44) than in SAB (34/44,26/44). In SAB, VEGF mRNA expression, VEGF 121 and 165 isoforms expression, synovial proliferation, vessel counts and density were more significantly expressed in diabetics than in non-diabetics. Shoulder joint contracture was more common in diabetics. In SAB specimens where the VEGF 165 isoforms expression was positive, the preoperative range of elevation was significantly limited. However, in RI specimens with a positive VEGF 165 isoforms expression, the limited elevation was significantly observed. Limited elevation and external rotation was also observed in synovial proliferation. These results suggest that VEGF 121 produced in vascular endothelial cells and synovial lining cells in SAB and rotator interval was closely related to the development of shoulder contracture in non- DM group. And overexpression of VEGF165 appeared to be specific in shoulder contracture of rotator cuff disease in type II DM.
The purpose of this study was to investigate the relationship between the grip strength and surgical results in rotator cuff tears. The materials for this study were 20 patients who underwent surgical repairs of the rotator cuff tears from 2000-2003. There were 14 males and 6 females with an average age of 58.5 years old. They were operated on by Mini-open repair in 4 cases, by McLaughlin's procedure in 10 cases and by a fascia lata patch procedure in 6 cases. Isometric muscle strength around the shoulders was measured by using a MicroFET, and grip strength was measured by using a dynamometer. Preoperative and postoperative results were evaluated according to the JOA score. The relationship between the grip strength and surgical results was investigated. The mean JOA score was 66.0 points preoperatively. had improved to 92.1 poionts at 1 year postoperatively. The mean grip strength was 31.6kg preoperatively, and had decreased to 25.8kg at 3 months postoperatively. Then it increased to 30.7kg at 6 months postoperatively, and it was 33.3kg, almost the same as the grip strength of non-operative and normal side (33.6kg) at 1 year postoperatively. The grip strength had a significant correlation with the muscle strength of 45 degrees shoulder abduction and external rotation in the affected side, but no correlation with the size of the tear and the JOA score. The mean grip strength decreased at 3 months postoperatively, then it increased to almost the same as the grip strength of non-operative side at 1 year postoperatively. The grip strength had a significant correlation with muscle strength of 45 degrees shoulder abduction and external rotation in the affected side at 1 year postoperatively.
We have transplanted a Leeds-Keio artificial ligament covered with patients' own iliotibial band from greater tubercle of the humerus to belly of supraspinatous muscle where blood supply seems sufficient. We investigated and evaluated the postoperative transplanted structures by motion MRI. We operated on 5examples of 5 shoulders, during the 40 rotator cuff reconstructions of 42 shoulders from April,2000 to March,2004. We evaluated the transplanted tissue by using 0.3T constant conduction MRI. Also we observed the movement of the transplanted tissue by motion MRI. Post operative evaluations were made according to the JOA score. The JOA score had increased from 9 to 28 in the pain score, from 8.8 to 18 in the functional score, from 49.5 to 82.2 in the total score, and each scale had improved statistically significantly(P<0.05). This postoperative T1-weighted MRI study showed transplanted tissue low intensity, which looked like a rotator cuff. Also it attended on the occasion of shoulder abduction. We were satisfied with our results of operative treatment for a rotator cuff tear.
Functional changes of the long head of the biceps brachii (LHB) tendon with rotator cuff tears are not well known though they presents various pathological changes. Optimal treatments for pathological LHB tendons are not well established. The purpose of this study was to assess morphology and localization of the LHB tendons with rotator cuff tears. We retrospectively evaluated MR arthrographies of 47 shoulders in 46 patients with surgically treated full thickness rotator cuff tears, and 8 shoulders in 8 people without a rotator cuff tear as control. Morphology and localization of the LHB tendon were evaluated with oblique sagittal images in the 4mm lateral plane parallel to the glenoid fossa. We measured three parameters: LHBw: the width of the LHB, LHBt: the thickness of the LHB and LHBa: the anterior displacement angle of the LHB. We analysed three parameters in four groups determined by the rotator cuff tear size: No tear (N), small (S), middle (M) and large (L). The average measurements were 9.60,9.60,10.42 and 12.22 respectively in LHBw,2.10,2.93,3.49 and 4.20 respectively in LHBt; 17.58,17.52,20.94 and 25.36 respectively in LHBa. The width and thickness of LHB tendons increased with the increase of rotator cuff tear size; the LHB tendons were displaced more anteriorly in the same manner.
It is very hard to reconstruct the shoulder function of global rotator cuff tear without long head of biceps tendon. The purpose of this study was to clarify indication and postoperative results of these patients. From 1995 to 2004,241 cases of rotator cuff tear were operated on this hospital. Fourteen cases of global rotator cuff tear were studied with the shoulder score of the Japanese Orthopaedic Association. The scores of pain, function, active day living, range of motion, XP and instability were improved postoperatively. Total points of JOA score was 60.7 points, preoperatively. It became to 83.7 points postoperatively. It had a significant improvement (t-test p<0.05). Totally, results were acceptable, but there were some small recovery cases. We should evaluate the function of the rotator cuff preoperatively and make clear indications. It was useful to graft semitendinous tendon and semimembranous tendon for a global tear of the rotator cuff without a biceps long head tendon.
We compared the clinical results and duration of the surgery between arthroscopic and open repair for rotator cuff tears. Ten shoulders of 10 patients (7 males, mean age 61.5 years old) with complete rotator cuff tear (5 small and 5 medium tears) were repaired by open surgery. In the open technique, the deltoid muscle was temporarily detached from the acromion and the tear was repaired by PanalokTM RC anchors. In another ten shoulders of 10 patients (5 males, mean age 59.8 years old), the cuff tear was repaired arthroscopically by FastinTM anchors. The mean follow-up period was 16.7 (14-21) months for open repair and 8 (5-12) months for arthroscopic repair. The clinical results were assessed by JOA score. The mean postoperative JOA scores were 95.1 (92-98) in open surgery and 93.6 (85-100)in arthroscopic procedure (no significant difference). The mean durations of surgery were 87 (40-145) minutes for open surgery and 192 (130-270) minutes for arthroscopic repair. Arthroscopic repair was minimally invasive, but required longer surgical time.
The of this study was to evaluate each relationship among the tension of the repaired rotator cuff, the size of the tear, the linear bands of the supraspinatus muscle scanned by MRI and the postoperative JOA score. The subjects were 29 patients (males24, females 5) with a rotator cuff tear of the shoulder aged 33 to 74 years old. We measured the tension of the repaired rotator cuff at the arm in O°,30°, and 60°abduction position by using a simple spring scale. Then we classified them into three grades of linear bands of the supraspinatus by MRI. The results were three shoulders in grade 1, ten shoulders in grade 2, and sixteen shoulders in grade 3. The larger the tears, the higher tension was needed to repair them, especially we could find a relation between the tension at the arm in 0° and 30° elevation and the size of the tear. A significant difference was not found between the size of the tear and the JOA score in this study. In every grade, there was no significant difference between the size of the tear and the JOA score.
To evaluate the muscular power of the shoulder in rotator cuff tear we determined the suitable operation method and physiotherapy plan. Although muscle volume can be measured by MRI, the correlation with actual muscular power is not certain. The purpose of this study was to evaluate the correlation of the muscular power which used Isokinetic Dynamometer, and muscle volume obtained by MRI picture measurements, and verifying the meaning of the muscular power evaluation. We evaluated MRI and shoulder muscular power using a Kinetic Communicator (KIN/COM) which was Isokinetic Dynamometer of 20 shoulders in 20 patients with surgically treated full thickness rotator cuff tears. Muscle volume was measured in oblique sagittal image in the inner side 25 mm of glenoid according to Zanetti's method, and the size of supraspinatus (SSP) was measured, and by considering the size of the supraspinatus fossa (SF) as control, the area rate was computed and it indicated by percent (SSP/SF). Musclar power was measured at 60 degrees/second load and 180degrees/second load using KIN/COM. The correlation of picture evaluation and survey muscular power was examined. KIN/COM measurement value was 10.5±6.6 (Nm) by 60 degrees/second load, and was 9.8±7.2(Nm) by 180 degrees/second load. Between a 180 degrees/second load value and SSP/SF, significant positive correlation was accepted. But a clear correlation was not accepted between a 60 degrees/second load value and SSP/SF. We judged that a high movement load state reflected the actual muscle volume in shoulder muscular power evaluation using Isokinetic Dynamometer, and was considered useful before an operation and postoperative evaluation.
To understand the mechanism of tendon cell proliferation eventually leads to stimulate the natural healing potential of the ruptured rotator cuff tendon. The aim of this study was to examine the proliferative activity of the tendon cells in torn supraspinatus tendon. Samples were collected from patients with full thickness rotator cuff tears undergoing shoulder surgeries. Tendon cell proliferation was assessed by immunolocalization of PCNA. The proliferative index measured by a computer system. We could detect proliferating tendon cells in our rotator cuff tendon samples by immunohistochemical analysis of the PCNA. The tendon cells in the distal area were significantly more proliferating compared to the proximal area. The proliferative index in the distal area for the large and massive size tear group was significantly higher compared to the small and middle size tear group. The proliferative index in the proximal area were the same. The proliferative activity of the tendon cell remained after the rotator cuff tear. It was strongly related to the location of the torn tendon and the tear size. This contributed to our understanding of the enhancement of the healing potential of untreated and surgically treated rotator cuff tendons.
Atrophy of rotator cuff muscles is an important factor influencing the outcome of rotator cuff repair. Accurate evaluation of the muscular volume was essential for good shoulder reconstruction. However, the relationship between the muscular volume evaluated with MRI and the rotator cuff tear size was not well determined. The aim of this study was to evaluate the comparison between these two parameters. We retrospectively evaluated MR images of 38 shoulders with surgically treated full thickness supraspinatus tendon tears, and 12 shoulders without a rotator cuff tear as control. Muscle volume was evaluated with oblique sagittal images in the 25 mm medial plane parallel to the glenoid fossa. Standardized cross-sectional areas (each rotator cuff muscle area divided by the area of the supraspinatus fossa (SF)) were measured as an indicator of the muscular volume according to the method of Zanetti et al. Supraspinatus (SSP/SF), infraspinatus and teres minor (ISP+TM/SF)and subscapularis (SBS/SF) were measured respectively. We compared these measurements between the tear group and the control group. We also analysed the correlation between these measurements and the tear sizes: longitudinal and transversal sizes. SSP/SF, ISP+TM/SF, and SBS/TM in the control group were 134±41,257±103,391±137, respectively. The measurements in the tear group were 100±29,226±80,345±128, respectively and SSF/SF was significantly decreased compared to the control. SSP/SF in the tear group was inversely proportional to the longitudinal tear size (r=-0.377) and the transversal size (r=-0.452) in a linear relationship. Shoulder muscular atrophy Was more correlated to the transversal rotator cuff tear size compared to the longitudinal tear size.
The purpose of this study was to address the influence of the tension of a rotator cuff repair on the postsurgical outcome and the shoulder abduction strength. Twenty-seven cases underwent a primary rotator cuff repair. Six cases were excluded due to a retear and bilateral rotator cuff tear. There were 20 males and 7 females. The mean age at operation was 63 (46-79) years old. At the time of repair, an osseous trough was created in the greater tuberosity. Then, the tension that the torn tendon cuff was attached to the trough was measured with a spring balance. Three measurements were taken at 0°and 30°of shoulder abduction. The JOA score and the postoperative isometric shoulder abduction strength were examined with a micro FET at average 26 (6-50) months in the follow-up. There was no correlation between the tension of rotator cuff repair and the JOA score. There was a strong positive correlation between the postoperative abduction strength and the tension of less than 3kg at 30°abduction (avr.: 94.5%, correlation coefficient:; 0.755), and a strong negative correlation between that strength and that with more than 3kg (avr.: 88.2%, correlation coefficient:; -0.837). If the tension of the torn cuff tendon showed about 3kg at the time of repair, the postoperative shoulder abduction strength might be restored very well.
Delamination is a frequently observed finding in shoulders with full-thickness rotator cuff tears. However, this pathology has not yet been described in detail in published clinical articles. The purpose of this study was to reveal the prevalence and characteristics of delamination. A consecutive series of 126 shoulders with fullthickness rotator cuff tear underwent arthroscopic rotator cuff repair. The patients consisted of 78 males and 48 females with an average age of 61 years old (range,36-81). Configuration of the proximal end of the torn cuff was carefully examined during arthroscopic surgeries. The prevalence and pattern of delamination and their relationship to age and gender were assessed with statistical analysis. Delamination was observed in 103shoulders (82%) and it extended proximally and posteriorly in the majority of shoulders. The deeper layers were thicker than the superficial layers in 80 shoulders (78%) and more retracted in 71 shoulders (69%). These findings were quite consistent in full-thickness rotator cuff tears less than 5cm in diameter. However, in shoulders with massive rotator cuff tears (more than 5cm in diameter), both the layers were equally retracted. The average age of patients with or without delamination was 62 years old and 57 years old, respectively, and this difference was statistically significant (p=0.04). Delamination was more frequently observed in females than in males with significant difference (p=0.006). This study demonstrated that delamination was frequently associated with full-thickness rotator cuff tears. The deeper layers were thicker and more retracted than the superficial layers in a majority of shoulders with a delamination.
The purpose of this study was to evaluate the outcome of rotator cuff tears repaired arthroscopically. Fifty patients with tears of rotator cuff who underwent arthroscopical rotator cuff repair since 2002. We evaluated 32 patients who were followed - up for more than 6 months. The mean follow-up period was 14.1 months (range 6-27 months). Patients were 14 males and 18 females. The average age at surgery was 64.9 years old (range 47-80years old). The average interval from onset of symptoms to the operation was 13.4months (range 296 months). The shoulder functions were assessed by means of the Japanese Orthopaedic Association shoulder scoring system (JOA score) before and after operation. The rotator cuff tears were repaired using suture anchors, margin convergence sutures, or both. The tear types were 4 partial tears (bursal side: 2, articular side: 2) and 28 complete tears (small: 9, medium: 10, large: 5, massive: 4). The average total score had improved from an average score of 56.3 points preoperatively to 92.7 points postoperatively. Each type after operation was 91.3(partial),93.1(small),95.3(medium),91.2(large) and 88.9(massive) points. There was a correlation between medium and massive type (p = 0.025). The average function score had improved from 10.0 points preoperatively to 18.5 points postoperatively, but there were correlations between massive and partial, small, medium types (p = 0.0157,0.0013,0.0486). The ratio of the partial tears and small tears had decreased over the 6months in the intervals between the onset and the operations. This study showed an almost satisfied clinical result, but the recovery of the function was difficult in a massive tear.
Global rotator cuff tears were difficult to treat because of the severe degenerative changes of the tendons and lack of material for repair. The purpose of this study was to correlate clinical factors with the outcome of repairs for global rotator cuff tears. From 1970 to 1999 a total of 1523 rotator cuff repairs were done. Included in this study were 181 global tears,377 massive tears, and 381 triangular tears. Frequency tables of the demographic and clinical data were collected from the medical records with a minimum of 1 year follow-up. In the global tear group,146 were males and 35 were females with an average age of 62.1 years old.119 right and 62 left shoulders. Among the factors studied, gender, laterality, occupation and history of trauma had no correlation with the type of tear. Patients with global tears tended to be older (62.1 y.o) and had longer duration of symptoms than those with triangular tears. Those with symptoms of more than 12 months duration tended to have poorer outcome with regards to MMT, ADL and pain. Tears repaired using McLaughlin's technique tended to have better MMT scores, ADL scores and a significant reduction of pain than those repaired with the side to side technique. In summary, the age, duration of symptoms, and operative technique correlated significantly with MMT, ADL and pain scores. We recommended that patients with global rotator cuff tears should be operated on as soon as possible because of utilization of McLaughlin's technique of which the tendon is sutured into a bony trough promoting bone-tendon healing.
The complications and MRI findings of 19shoulders in 17patients with the degenerative rotator cuff tears and the bony spur of more than 3 mm at the greater tuberosity were investigated. The average age was 71.3 (41-91). The presence of an effusion in the subacromial bursa, a nodular lesion on the synovial membrane and a thin portion of the deltoid muscle were evaluated by MRI images. Fourteen shoulders were treated conservatively and five were operated. Rotator cuff repairs with acromioplasty were done in all five shoulders and the spur excision and partial synovectomy were added in 1 and only spur excision in 2 shoulders. Complications were observed in 6 shoulders. Recurrent bleeding in the subacromial bursa (Idiopathic intraarticular hemorrhage of the shoulder joint) in 2, rupture of the deltoid muscle at the insertion in 2, severe knocked pain at the spur in 2 were observed. MRI images showed a massive effusion in 17 shoulders, nodular lesions of the synovial membrane in 5 and a thin portion of deltoid muscle in 3 shoulders. Postoperative results were good in all 5 shoulders. Intrasynovial hematoma of a subacromial bursa was observed pathologically in one shoulder with idiopathic intraarticular hemorrhage of the shoulder joint. Bony spurs at the greater tuberosity of the humerus with degenerative rotator cuff tears may cause an idiopathic intraarticular hemorrhage or a rupture of the insertion of deltoid muscles. The operative treatments of spur excision and partial synovectomy were recommended.
Periarthritis of the shoulder is characterized by freezing phase, frozen phase, and thawing phase. However, the pathology of its clinical course is not clarified. Recent development of shoulder open surgery, arthroscopy, MRI and PET demonstrated that shoulders with persisting pain and contracture had hyperemia and edema of the joint capsule and subacromial bursa. Thus, we tried to elucidate clinical phases of frozen shoulder based on connective tissue repair and remodeling. Early freezing phase of the shoulder is consistent with acute inflammatory phase of connective tissue repair. In this period, edema and hyperemia of the shoulder joint capsule appears with occurrence of shoulder pain (0 to 1 month from the onset). Late freezing phase of the shoulder is consistent with fibroplasias of connective tissue repair. In this period, infiltration of fibroblasts and new vessels in the capsule appears with progressive pain and reduction of range of motion (1 to 2 months from the onset). Freezing phase of the shoulder is consistent with consolidation stage of remodeling of connective tissue repair. In this period, fibrosis and thickening of the joint capsule appears with progressive contracture (2 to 6 months from the onset). Thawing phase of the shoulder is consistent with maturation stage of remodeling of connective tissue repair. In this period, remodeling of joint capsule appears with gradual relief from joint contracture (6 month to 1 year from the onset). Joint capsule of the shoulder is known to have enough redundancy. However, if the inflammation of the capsule spreads all over the shoulder joint, fibrosis and production of collagen fibers in the capsule develops. Subsequent relief form joint contracture with remodeling of the capsule explains characteristic features of clinical staging of periarthritis of the shoulder. Comparing clinical stage and extent of connective tissue repair, theoretical back ground of physical therapy and surgical treatment is evident.
The acromioclavicular joint(ACJ) is a common site of shoulder-related pain and is often associated with subacromial impingement syndrome. We reported on the arthroscopic operation and the open resection of distal clavicle were effective procedures for acromioclavicular osteoarthritis with cuff tendinopathy. The purpose of this study was to evaluate the histological pattern of osteoarthritic cartilage of ACJ. Between October 2002 and September 2004, this study involved 23 shoulders in 23 patients: 13 men,10 women. The average age at the time of surgery was 60.2 years old (range,45-70 years old). We stained them with hematoxylin and eosin. HE sections of the,23 shoulders were graded according to the modified Mankin's structure system (grade0: normal, gradel: surface irregularities, grade2: clefts to transitional or radial zone, grade3: clefts to calcified zone, grade4: no cartilage layer or complete disorganization). Safranin O sections were graded according to Mankin's system(grade0: normal, gradel: slight reduction, grade2: moderate reduction, grade3: severe reduction, grade4: no dye noted). The grading of the HE staining showed grade0: 11specimens, grade1: 31 specimens, grade2: 35 specimens, grade3: 25 specimens, grade4: 36 specimens. The grading of the safranin O showed grade0: 8 specimens, grade1: 21 specimens, grade2: 20 specimens, grade3: 42specimens, grade4: 47 specimens. This histological examination of these ACJ demonstrated the variation in the osteoarthritic changes in the cartilage.
The purpose of this study was to evaluate 4 patients with marked atrophy of the shoulder girdle muscles caused by degenerative processes of cervical spine.4 patients presented themselves with deltoid paresis with the absence of sensory deficits or myelopathy. The patients were 3 males and one female. Their age at treatment was from 49 to 74 years-old with an average of 61.7 years old. Their mean follow-up period was 17months (17-29).3 cases underwent a cervical anterior decompression and one case was treated conservatively. The severity of deltoid paralysis was classified into five grades according to the manual motor power test and swallow tail sign. Theclinical outcome of each case was evaluated at pretreatment and at followup with JOA scores. Of 4 patients, three had C4/5 cervical spondylosis and one had C4/5 and C5/6. In the all cases, muscle power had improved significantly from MMT 2 to MMT 5. The JOA scores averaged 65.8 points at pretreatment and 98.8 points at follow-up. It is important for the differential diagnosis of shoulder girdle damage in cervical spondylotic syndrome of rotator cuff tears. The swallow tail sign in diagnosis and treatment was effective for a cervical spondylotic amyotrophy.
Septic arthritis of the shoulder in children may result in deformity of the proximal humerus, humeral shortening or subluxation of the shoulder joint; however, there are very few reports with a long-term follow-up. The purpose of this study was to clarify a sequel of septic arthritis in infants. Sixteen shoulders in 15 patients were retrospectively evaluated from clinical records and plane radiographs. Follow-up terms ranged from 5.0to 17.9 years (average: 11.3 years). The average age at first onset and final X-ray examination was 0.8 years old and 11.6 years old, respectively. Arthrotomy was performed in 6 shoulders (Group A) within 10 days after the first onset. Of the remaining 10 shoulders,4 shoulders (Group B) were treated with arthrotomy more than 10days after first onset and 6 shoulders (Group C) were managed conservatively with needle aspiration and intravenous antibiotics. The mean follow-up terms were 11.0,11.9 and 11.3 yeas in Group A, B and C, respectively. In the latest follow-up radiographs, deformity of proximal humerus was identified in 2 humeri in Group A,4 in Group B and 5 in Group C. Inferior subluxation of the shoulder was not observed in Group A, however, it was observed in 2 shoulders in Group B and 3 in Group C. The mean discrepancy of the humeral length at final X-rays were 0.1 cm,3.2 cm and 5.3 cm in Group A, B and C, respectively. The difference between Group A and C was statistically significant (ANOVA combined with Fisher's PLSD: p=0.014). Humeral shortening was related to inferior subluxation and 3cm-shortening seemed to be critical in these cases. Early drainage by arthrotomy was necessary to avoid humeral shortening and consequent subluxation of the shoulder.
The purpose of the present study was to investigate the anterior type partial rotator cuff tear in throwing injuries of the shoulder. Thirty-three shoulders, who underwent arthroscopic surgery due to a throwing injury and in whom a rotator cuff tear was recognized, were investigated. First, they were divided into 2 groups according to the cite of the tear: the anterior type in 13, in which the tear was located at the anterior part of the suprasupinatus tendon, and the posterior type in 20, in which the tear was located around the border between the suprasupinatus and the infraspinatus tendon. Then, the patient's profiles, range of motion and joint laxity under general anesthesia, and the operative findings were compared between the 2 groups. As a result,10 of 13anterior type rotator cuff tears were restricted at the anterior 1/3 part of the supraspinatus tendon, and concealed type tears, in which an intratendinous degenerative tear was observed after a residual articular-side capsular portion was debrided, were recognized in 5. Posterior joint tightness at 90-degrees abducted position on examination under general anesthesia was recognized in 13 (100%) in the anterior type and in 13 (65%) in the posterior type, and posterior capsular tightness at arthroscopy was recognized in 11 (85%) in the anterior type and in 10 (50%)in the posterior type. Moreover, the greater tuberosity notch was recognized in 3 (23%)and 18(90%), respectively, and those factors showed a statistically significant difference. In conclusion, as the concealed type tear seen at the anterior part of the supraspinatus tendon was a representative lesion in an anterior type rotator cuff tear, the mechanism of an anterior type rotator cuff tear was suggested to be different from the posterior type. Posterior capsular tightness significantly related to the existence of anterior type rotator cuff tear. The presence of the greater tuberosity notch was seldom seen in the anterior type tear.
We reported on the features of arthroscopic findings and the clinical results of surgical treatment of a rotator interval lesion (RIL) in a throwing injury. We operated on 14 baseball players with RIL (all men, mean age: 24.7y. o). All patients complained of throwing disturbance and 75% patients complained a severe dullness around the shoulder. We recognized anterior and inferior instability in all cases. At first, gleno-humeral joints were observed under arthroscopy and rotator intervals were repaired by Nobuhara's method. Debridement of the labrum and synovectomy were done arthroscopically. Cuff repair was done in one patient who was 14years old. The surgical results were evaluated according to JSS sports score. The mean follow up period was 2.9years. In arthroscopic observation,7 cases of SLAP lesions,6 cases of incomplete cuff tears,12 cases of SGHL injuries,8 cases of MGHL injuries,5 cases of anterior labrum injuries,8 cases of posterior labrum injuries,5cases of synovitis at the rotator interval, and 3 cases of synovitis at LHB were seen. JSS sports score improved from 41.6-86.6 points. Limitation of shoulder ROM was not seen in any cases. Although various findings were seen under arthroscopy, it seemed that RIL was the main lesion and other findings had occurred due to instability caused by RIL. Surgical repair of the rotator interval was effective for RIL in the throwing injury. The correction of the throwing form is needed to prevent the recurrence of RIL.
The purpose of this study was to clarify the surgical outcome and the complication of the painful throwing shoulders with the use of thermal capsular shrinkage (TCS). We retrospectively studied 15 throwing athletes ranging from 17 to 31 years of age (average,21.1 years old). Thirteen baseball, a softball and a volleyball player were included. The mean follow-up was 17 months (range 12-34 months) after surgery. Arthroscopically, SLAP lesions were recognized in 7 cases and posterosuperior labral injuries in 7 cases. In these cases, internal impingement was revealed in 6 cases. Electrothermal capsular shrinkage was performed in all cases (anterior 9 cases, posterior 5 cases and both in one case). Arthroscopic debridement of the torn and detached labrum was performed in 14 cases, arthroscopic debridement for the articular-side partial rotator cuff tear was performed in 7 cases, arthroscopic repair of anterosuperior labrum was in 2 cases. We evaluated the throwing pain and the function with the shoulder sports score of Japan Shoulder Society (sports score). Thirteen of fifteen cases (86.7%) returned to their preoperative sports level from 4 to 12 months (average 7.3 months). The average pain score at preoperation was 3.3 points and the function score was 6.3 points. At the time of the last investigation, the pain score was 21.7 points and the function score was 27.7 points. We had a complication of TCS with the anterior capsular perforation in one case. The surgical outcome for throwing athletes with the use of TCS were satisfactory, but it was necessary to take care of the complication of capsular perforation.
The aim of this study was to elucidate the relationbetween internal (IR) and external rotations (ER) strength of the shoulder and shoulder pain during throwing in high school baseball pitchers. Internal and external rotation strength of the shoulder were measured in 401 high school pitchers, who had attended the national inter high school baseball tournament in Japan, and the influence of internal and external rotation strength of shoulder on shoulder pain during the throwing were assessed. The average IR and ER strength were 105.3+/-32.2N and 93.1+/-28.3N. The average IR. ER, and ER/IR ratio were 1.18+/-0.22,0.98+/-0.14, and 0.92+/-027, respectively, in all pitchers. All pitchers were classified into two groups. The pain experienced group (P group), which involved the pitchers who had experienced shoulder pain during throwing prolonged more than one month within the year, included 40 pitchers, and the other group (NP group) included 361 pitchers. The IR, ER, IR ratio, ER ratio, and ER/IR ratio were compared between both groups. The ER/IR ratio of the P group was lower than that of the NP group, with a statisticaldifference by unpaired student t-test (p=0.02). Pitchers with a low ER/IR ratio tend to injure their throwing shoulder and proper ER/IR ratio could be one of important condition for throwing shoulders.
It has been reported that the repetitive throwing activity leads the dominant shoulder joint to have characteristic features. However, it is unclear if these features are related to the onset of throwing shoulder pain. The purpose of this study was to clarify the features of shoulder associated with throwing shoulder pain in high school baseball players. We examined the range of motion, laxity and muscle strength of both shoulders in 57 baseball players in high school. Regarding to the range of motion, flexion, external rotation and internal rotation at 90 degrees of abduction were measured. The strength in the following muscles was measured with a hand-dynamometer (MICRO FET): the abductor at 45 degrees of scaption, the external and internal rotators at the hanging arm. In addition, the laxity in the shoulder was evaluated with the load and shift test. Fifty-seven players were divided into three groups according to their throwing shoulder pain; group N consisted of 26players with no shoulder pain, group P consisted of 9 players with throwing shoulder pain at the examination, group NP consisted of 22 players with throwing shoulder pain in the past. The statistical analysis was done using a one-way ANOVA. The external rotation and range of rotation (external and internal rotation) of the throwing shoulder in group P was significantly less than those in the other two groups. There was no significant differences in the range of flexion andinternal rotation, the laxity andthe strength of the shoulder among the three groups. The decrease of external rotation in the dominant side might cause throwing shoulder pain in high school baseball players.
We had medical checks of baseball injuries of the shoulder joint of junior and senior high school students in Kochi Prefecture during 1997and 2002.116junior high school baseball players and 76 high school players were investigated by means of a questionnaire and physical examination in 1997.105junior high school and 95 senior high school baseball players in 1998.33 junior high school and 87 high school baseball players in 1999.84 junior high school and 85 high school baseball players in 2000.46 junior high school and 88 high school baseball players in 2001.48junior high school and 94 high school players in 2002. Almost 30% of the junior high school and high school baseball players showed a painful condition and overused states of their shoulder joints in 1997and 1998. However, the ratio of the painful condition of the baseball players decreased every year. Our results suggest that an early search for shoulder injuries in young baseball players is useful for treating throwing injuries of the shoulder joint.
The purpose of this study was to know the characteristic of the trunk rotation in the throwing athletes and to demonstrate that a new method (The trunk rotation test; TR test) for evaluating the trunk rotation is useful. We studied 105 throwing players of baseball and volleyball (throwing group; 93 males and 12 females) who had consulted our clinics for a medical check-up with a mean age of 18.0 years old. We examined them on the TR test performing as follows: Subjects sat on the table for examination with their feet not touching the floor, their shoulders were flexed and internally rotated at 90 degrees with each hand touching the opposite shoulder, and then we evaluated the trunk rotation of the bilateral sides. We considered the test positive when the rotation angle of the throwing side was clearly lower than that of the non-throwing side. We compared the positive ratio of the TR test between the throwing group and the non-throwing group consisting of 56 nonthrowing athletes such as football. In the throwinggroup,47 subjects of 105 (45%) were positive, While in the non-throwing group,10 sublects of 56 (18%)were positive (P<0.05). This study showed that in the throwing athletes the trunk rotation to the throwing side were more restricted than that in thenon-throwing athletes, and this restriction of the trunk rotation will cause the throwing shoulder more stress.
Recent reports on throwing shoulder injuries were mainly on young players and there were limited reports on middle-aged and elderly players who kept on playing baseball. In this report,12 middle-aged and elderly players and 10 young players were studied. We examined the arthroscopic findings from the operations, the range of motion of the internal and external rotation at the shoulder 90 degrees abduction, the isokinetic shoulder muscle strength, and the trunk flexibility compared with young players. As the arthroscopic findings, anterosuperior labrum tear, severe rotator cuff tear and chondral lesion of humeral head were foundin elderly players more often than young players. Also, decrease of the range of motion, shoulder external and internal rotational muscle strength, shoulder extension endurance muscle strength and trunk flexibility were found in elderly players. Through our study, we found out that middle and elderly players could return to play with appropriate rehabilitation and assessment not only of the shoulder but also of all over the body.
Type II superior labrum anterior-posterior (SLAP) lesion is a common injury for throwers as well as increased anterior shoulder capsuloligamentous laxity. However there is no biomechanical study of the effects of type II SLAP lesion with increased shoulder capsuloligamentous laxity. The purpose of this study was to investigate the effects of an experimentally created type II SLAP lesion, and anterior capsuloligamentous laxity on glenohumeral translation and rotational range of motion. Six fresh frozen cadaveric shoulders were tested using a custom shoulder testing system and Microscribe. Excessive humeral external rotation (20% beyond the maximum external rotation)was applied at 60°of glenohumeral abduction to yield a detachment of superior labrum and an elongation of anterior shoulder capsule. The experimentally created type II SLAP lesions were then repaired arthroscopically. The rotational range of motion was measured at 60°glenohumeral abduction. Glenohumeral translations were measured at O,30 and 60°glenohumeral abduction in neutral rotation and 90°extemal rotation. External rotation was significantly increased by 20.8±2.1°after excessive external rotation and decreased by only 4.0±0.7°after a SLAP repair. Anterior and tnferior translations were significantly increased at all positions after excessive external rotation and decreased at 30°glenohumeral abduction and neutral rotation and at O°glenohumeral abduction and neutral rotation, respectively, after SLAP repair. All experimentally created type II SLAP lesions were associated with elongation of the anterior capsular ligaments. For a type II SLAP lesion with anterior shoulder instability or anterior pathologic laxity at 90°of shoulder abduction(60°glenohumeral abduction), as seen in throwers, an increased external rotation and an increased anterior and inferior shoulder joint laxity at 90°shoulder abduction may be due primarily to elongation of the anterior capsular ligaments. Therefore, anterior shoulder ligamentous laxity should be addressed in addition to SLAP repair.
It seems that there are few patients who require surgery as a treatment of injection or rehabilitation. Arthroscopic capsular release makes it possible for early rehabilitation after surgery. Therefore we performed arthroscopic capsular release for shoulder stiffness in patients who had not improved with rehabilitation. Arthroscopic capsular release was undertaken for the 18 shoulder stiffness patients in 43 patients of shoulder arthroscopic surgery from August 2002, in our hospital. They were 15 males and 3 females with a mean age of 51.6 years old. The mean period after surgery was 8.6 months (from 6 months to 13 months). We released the anterior capsule with VAPR and the lasp that is always used for a Bankart's repair. The adhesions of LHB and SSP were also released. We analyzed the JOA scores before and after arthroscopic capsular release. The JOA score had increased from 47.7 to 90.3. Pain had improved from 7.78 to 25.8. Function had improved from 10.2 to 17.8. ROM had improved from 10.1 to 26.9. Therefore using lasp for Bankart's repair was useful for arthroscopic capsular release. During surgery it was easy to geta better ROM after manipulation. We plan to analyze these results in the long term after surgery.
The purpose of this study was to determine the diagnostic values of various physical examinations for a SLAP lesion. MR arthrography was performed in 77 shoulders (74 males and 3 females). The mean age was 24.8 years old. Sensitivity, specificity and accuracy were calculated using the crank test, pain provocation test (Mimori test), O'Brien's test, anterior apprehension test, impingement test(Neer and Hawkins), the sulcus sign, load &shift test, and tenderness of the rotator interval. In 46 shoulders, superior labrum detachments were recognized on MR arthrography. The sensitivities were 96% in the crank test,80% in the pain provocation test,72% in O'Brien's test, and 87% in the anterior apprehension test. The specificities were 28% in the crank test,74% in the pain provocation test,71% in O'Brien's test, and 42% in the anterior apprehension test. Accuracies were 68% in the crank test,78% in the pain provocation test,72% in O'Brien's test, and 69% inthe anterior apprehension test. Joint laxity tests showed a low sensitivity, but high specificity. We thought that the physical tests for a SLAP lesion were not so available for the diagnosis.
We investigated the clinical course of each age-group following hemiarthroplasty for a displaced fracture of the proximal humerus. There were 13 patients with 15 shoulders (mean age at injury: 77.5 years old,1 man and 12women) who underwent surgery for a displaced fracture of the proximal humerus. All patients were operated on by hemiarthroplasty. We divided 15 shoulders into 3 groups by age at injury. There were 3 shoulders in the seventh decade group,5 shoulders in the eighth decade group and 7 shoulders in the ninth decade group. We investigated the shoulder function using the Japanese Orthopaedic Association (JOA) score and shoulder flexion at 3 months,6 months, and 12 months postoperatively. In the seventh decade group, the JOA score was 77 points,90 points, and 98 points (3 months,6 months, and 12 months postoperatively: the same as above) and shoulder flexion was 98 degrees,110 degrees, and 150 degrees. In the eighth decade group, the JOA score was 71 points,85 points, and 88 points, and shoulder flexion was 82 degrees,95 degrees, and 118 degrees. In the ninth decade group, the JOA score was 69 points,75 points, and 76 points, and shoulder flexion was 71 degrees,81 degrees, and 83 degrees. Functional recovery improved up until 12 months after hemiarthroplasty and the outcome was the most excellent in the seventh decade group. Remarkable functional recovery was not obtained after 6 months postoperatively in the eighth decade group and ninth decade group. So, early time exercises before 3months postoperatively were very important for functional recovery in patients more than 70years old.
Postoperative pain from shoulder surgery is so severe that it may influence postoperative rehabilitation, and occasionally induce reflex sympathetic dystrophy. As a pain control, we used anesthetics. Thirty-six patients were studied. The patients consisted of 25 patients@with traumatic anterior shoulder instability (A group), and 11 patients with a rotator cuff tear (B group). In A group, a catheter was inserted into the glenohumeral joint. In B group, a catheter was inserted in the subacrominal bursa. Through the catheter,0.2% ropivacaine hydrochloride was administered continuously for 48 hours. The frequency and the kind of analgesics that were used postoperatively were recorded. Seven patients with traumatic anterior shoulder instability (C group) and 12 patients with a rotator cuff tear (D group) who did not receive anesthetic administration served as controls. Five patients in A group,7 in B group,6 in C group and 12 in D group required another analgesic treatment. Supplementary use of analgesics, and narcotics were significantly more frequent in C and D groups. The postoperative continuous administration of anesthetic was effective in controlling postoperative pain after shoulder surgery.