巻号一覧
33 巻 (2009)
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33 巻, 3 号
選択された号の論文の64件中51～64を表示しています
その他
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山口 光國, 筒井 廣明2009 年 33 巻 3 号 p. 805-808
発行日: 2009年
公開日: 2010/01/29
ジャーナル 認証ありWe investigated the movement of the shoulder girdle which included the humerus position that athletes need to throw. We examined the movement of the shoulder girdle and relations with the state of the shoulder which we were aware of. The materials were 53 athletes to know their throwing movement. Their average age was 17 - 38 years old. (average 24.4±4.8) The results, the shoulder condition and the relations with the range of motion accepted middle-class correlation for the external rotation and internal rotation movement in the state of 90° flexion. The shoulder condition and the relations with the movement of the shoulder girdle accepted strong correlation in anterior, superior, inferior and the posterior recognized middle-class correlation. The result of this appraisal method did not accept significance between the pitching side and the un-pitching side. (p<0.01) The movement of the shoulder girdle on the basis of the humerus strongly influenced the condition of the shoulder of which we were aware of rather than the range of the shoulder motion. Although ROM was important as a medical treatment, it cannot be said that it was enough in respect of prevention of an obstacle. This evaluation method was important from a viewpoint of injury prevention to it. And this method was simple and we thought very easy to use.抄録全体を表示PDF形式でダウンロード (638K) -
浜田 純一郎, 五十嵐 絵美, 遠藤 和博, 佐原 亮, 矢野 雄一郎2009 年 33 巻 3 号 p. 809-813
発行日: 2009年
公開日: 2010/01/29
ジャーナル 認証ありThe shoulder joint is composed of the glenohumeral (GH) joint and the scpulothoracic (ST) joint. The purpose of this study was to identify which joint was contracted in various stiff shoulders: frozen shoulder (FS), rotator cuff tear (RCT), calcific tendinitis (CT), postoperative contracture (fracture), and diabetes mellitus (DM). 49 patients with stiff shoulder (23 males, 26 females, average age: 54 years old): 27 shoulders with FS; 11 with RCT; 6 with CT; 6 with fracture; and 8 with DM were investigated in this study. We recorded ROM of bilateral shoulder joints, pain of passive motion at the sternoclavicular joint, mobility of bilateral scapulas, and measured ROM of the GH and ST joints, with 3DCT. We identified that 27 shoulders with FS had increased motion of the ST joint, hence ROM of GH joints were restricted. The same abnormality of the ST joint was observed in patients with RCT, CT, and fracture groups. However, the ROM of both GH and ST joints were restricted in patients with DM. Increased motion of the scapula was also verified with 3DCT in patients with FS, RCT, CT, and fracture. The GH joint was restricted in all patients, and stiff motion of the ST joint was only observed in 7 of 8 patients with DM.抄録全体を表示PDF形式でダウンロード (664K) -
中村 和史, 渡邊 幹彦2009 年 33 巻 3 号 p. 815-818
発行日: 2009年
公開日: 2010/01/29
ジャーナル 認証ありWe think SLAP lesions lead to anterior instability of the shoulder. On the other hand, we have some experiences of insufficiency of SGHL/MGHL without SLAP lesion. So we have investigated arthroscopic findings of the rotator interval in throwing shoulder since 2001 and make a hypothesis of path mechanics between insufficiency of SGHL/MGHL and RI lesion. 78 baseball players were studied. 62.9% (38 of 62) of articular-side-incomplete rotator cuff tears were consolidated with SLAP lesions. 33.3% (8 of 24) of articular-side-incomplete rotator cuff tears without SLAP lesion had tenderness of the lateral side of the coracoid process, inferior sublaxation during internal rotation of the arm, and radiopaque dye pouting into the RI space in arthrogram. They had abnormal findings of SGHL/MGHL. We considered RI lesion as the same as SGHL/MGHL insufficiency. SLAP lesions (anterior type) induce insufficiency of SGHL/MGHL. We concluded that the improvement of SGHL/MGHL function is very important in treating throwing shoulder.抄録全体を表示PDF形式でダウンロード (537K) -
小林 勉, 高岸 憲二, 大沢 敏久, 山本 敦史2009 年 33 巻 3 号 p. 819-822
発行日: 2009年
公開日: 2010/01/29
ジャーナル 認証ありConventionally, there were many studies about the efficacy of muscular assessment for throwing shoulder injury. On the other hand, there was no report regarding utility of the self-assessment for throwing performance. In this study, we reported whether the evaluations of muscular strength of the shoulder joint contribute to the throwing performance. 126 pitchers affiliated with the Gunma Prefecture High School Baseball Federation in 2007 had medical checkup and evaluated the examination items. Each player was also surveyed on his pitching performance by questionnaire at the examination. All players were male, the average baseball career was 98.5 (10 ∼ 240) months and 68 pitchers (50.8%) had current and past shoulder pain. The average maximum pitching speed was 125.1 (100 ∼ 140) km/h. By logistic regression analysis, the significant item about classification of the performance of the pitcher was throwing side external rotation strength at 0 position. The evaluation of external rotation strength at 0 position may be important when a baseball pitcher cared for the environment of his shoulder joint.抄録全体を表示PDF形式でダウンロード (443K)
治療法
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北原 博之, 松尾 麻未2009 年 33 巻 3 号 p. 823-826
発行日: 2009年
公開日: 2010/01/29
ジャーナル 認証ありPost-treatment of arthroscopic rotator cuff repair generally involves exercise with passive range of motion (ROM) for 3 weeks before gradually stepping up to performing active exercise. However, issues of muscle excitation in the vicinity of the shoulder/scapula may be occasionally encountered. As a result, apart from cases where contracture around the shoulder joint occurred, clinicians also encountered cases with long-term inability to acquire normal exercise of the joint. As such, we strategically attempted post-surgical rehabilitation using the sling-and-strap method to establish early active exercise with adequate relaxation of the muscles around the shoulder and without exerting stress on the rotor cuff repair sites. Arthroscopic rotator cuff repair cases subjected to surgical treatment between calendar years 2007 and 2008 were divided into 2 groups of 20 each: those treated with either sling-and-strap method incorporating early active exercise (Group 1) or conventional treatment method (Group 2). ROM scores of the shoulder joint at 1, 3, and 6 weeks and scapulohumeral rhythms more than 2 months after surgical treatment were monitored. The outcome revealed that improvements of ROM scores and normalization of scapulohumeral rhythm were obviously more pronounced in Group 1 than Group 2. In cases where the sling-and-strap method was adopted (Group 1), muscles in the vicinity of the shoulder were able to relax, thus effectively facilitating rehabilitation with muscle coordination exercise to eventually normalize the shoulder-joint function.抄録全体を表示PDF形式でダウンロード (461K)
症例報告
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岩田 玲, 松橋 智弥, 大泉 尚美, 三浪 明男, 末永 直樹2009 年 33 巻 3 号 p. 827-830
発行日: 2009年
公開日: 2010/01/29
ジャーナル 認証ありThe methods for repair of massive rotator cuff tears are tendon transfer procedures, transfers of free autograft tendons, transfers of arograft rotator cuff, and using non-absorbable synthetic materials. We have obtained good clinical results for short times using Teflon patch for reconstructive surgery of irreparable defects of the rotator cuff. But, it was pointed out that resorption of bone at the insertion point of Teflon patch occured in about 30% of patients after 2 to 5 years. We experienced a case of tough disorders and massive resorption of bone after a Teflon patch augmentation for massive rotator cuff tear of the shoulder 14 years ago. We operated on this case with debridment, synovectomy, shoulder arthroplasty and autograft for the glenoid articular fossa suffered from synovitis. In this operation, we found granulation tissues and absorption of bone adjacent to the Teflon patch at the head of humerus and the gleno-humerus joint invaded synovium. The humerus head was sized down, so this rotator cuff was successfully sutured. In conclusion, according to this case, we thought that non-absorbable synthetic materials like a Teflon patch should not be applied simply because of massive rotator cuff. Severe joint disfunction may occur after insertion of synthetic materials.抄録全体を表示PDF形式でダウンロード (396K) -
内藤 聖人, 最上 敦彦, 桐村 憲吾, 金子 和夫2009 年 33 巻 3 号 p. 831-833
発行日: 2009年
公開日: 2010/01/29
ジャーナル 認証ありValgus impacted fractures of the proximal humerus are often treated conservatively. However, malunion of the tuberosities will lead to impingement of the shoulder joint. We reported on a case of malunion of the lesser tuberosity after valgus impacted fracture which caused limitation of range of motion (ROM). A 64-year-old woman fell (30 months prior to a recent presentation). Radiographs showed a previous valgus impacted fracture of the right proximal humerus. Fracture was healed, but the limitation of ROM remained. CT showed that there was a malunion of the lesser tuberosity, resulting in limitation of adduction. We treated this impingement by corrective osteotomy. The lesser tuberosity with subscapularis muscle was removed from the humeral head with an osteotome. The lesser tuberosity was then fixed in its original position. At 2-year follow-up, she returned to work and demonstrated a significant improvement in ROM. Our patient presented herself with limited ROM due to malunion of the lesser tuberosity, and CT image demonstrated the resulting impingement. Corrective osteotomy proved to be an effective management technique. However, the important issue with this injury was initial management. CT image is a very effective examination tool that assesses whether tuberosity displacement will cause limitation of ROM. The choice of CT scan as an initial management technique is useful for both nonoperative care and internal fixation.抄録全体を表示PDF形式でダウンロード (346K) -
向井 章悟, 中川 泰彰2009 年 33 巻 3 号 p. 835-838
発行日: 2009年
公開日: 2010/01/29
ジャーナル 認証ありWe experienced a case of locked posterior fracture-dislocation of the shoulder. A 38-year-old man suffered posterior fracture-dislocation of his right shoulder associated with anatomical neck fracture of the humerus by a traffic accident. The fragment was locked at the posterior edge of the glenoid, so that a closed reduction had failed. He was treated by an open reduction, and the fragement was fixed by 3 cancellous screws. At the final follow up, his shoulder was stable and showed no instability. MRI scans showed small region of osteonecrosis in the cephalic portion of the antero-medial part of the humerus, but X-rays showed no deformity of articular surface or arthritic changes. The ROM was slightly limited, but the patient returned to work with no pain, and the JOA score was 85 points.
Posterior fracture-dislocation of the shoulder is very rare and the highly displaced fragments often prevent a closed reduction. In these locked cases, closed reduction are not usually atraumatic and the open anterior reduction may be better. Recently, some reports showed arthroscopically assisted reduction was useful in the point that it enabled the evaluation of torn posterior capsule or labrum immediately after the successful reduction. It is controversial if these Reverse Bankart lesions should be repaired at the initial reduction, but this method is less invasive and worth trying. On the contrary, an open reduction have the risk of soft tissue injury, which may lead to severe contracture and late segmental collapse of the humeral head. In this case, the area of the osteonecrosis was limited and the articular surface was preserved, which revealed satisfying results. We should not hesitate the open reduction in irreducible cases.抄録全体を表示PDF形式でダウンロード (452K) -
山口 蔵人, 大沢 敏久, 小林 勉, 山本 敦史, 設楽 仁, 高岸 憲二2009 年 33 巻 3 号 p. 839-842
発行日: 2009年
公開日: 2010/01/29
ジャーナル 認証ありWe presented an arthroscopic fixation technique for 2 patients with avulsion fracture of the greater tuberosity(GT) associated with anterior dislocation of the shoulder. (Case 1) A 66-years-old woman was injured when she hit the ground on her right shoulder. She had been diagnosed with anterior shoulder dislocation and had a closed reduction. 12 days after her injury, she visited our hospital. X-rays revealed a 20mm-upper displacement of avulsion fracture of GT. 18 days after her injury, an arthroscopic operation was performed. Anterior labrum had fissure but not detachment from the anterior glenoid rim. The tension of AIGHL was good. The upper side of SSC tendon was partial rupture. We performed an arthroscopic repair of partial SSC tear using 1 anchor and the arthroscopic fixation of avulsion fracture of GT using 3 anchors (suture bridging technique). (Case2) A 68-years-old woman was injured when she hit the ground on her left shoulder. She had been diagnosed with anterior shoulder dislocation and had a closed reduction. 13 days after her injury, she visited our hospital. X-rays revealed a 10mm-upper displacement of avulsion fracture of GT. 17 days after her injury, an arthroscopic operation was performed. There were no Bankart lesion, capsular tear or SSC tendon rupture. We performed the arthroscopic fixation of avulsion fracture of GT using 3 anchors (suture bridging technique). Arthroscopic fixation was an effective method for avulsion fracture of GT and then for reconstructing other lesions associated with shoulder dislocation. At the anchor fixation, we should be careful of loosening of the anchor due to fragile bone.抄録全体を表示PDF形式でダウンロード (506K) -
金子 正利, 尼子 雅敏2009 年 33 巻 3 号 p. 843-846
発行日: 2009年
公開日: 2010/01/29
ジャーナル 認証ありLung cancer metastasis to skeletal muscles is rare. We treated a patient with pulmonary adenocarcinoma who presented himself with metastasis to the deltoid muscle. Case:A 68-year-old man who complained of right shoulder pain visited a local physician. He was diagnosed with periarthritis scapulohumeralis and administered conservative treatment (steroid injection and physical therapy). Progressive severe pain continued for 3 months, leading the patient to consult with us. His shoulder appeared swollen and red and was warm. He had a history of diabetes, but not of trauma. Physical examinations confirmed that the active range of motion was restricted to 80° both in flexion and abduction. Blood examination findings suggested purulent arthritis of the shoulder and revealed severe anemia. Enhanced MRIs showed 8 × 6 cm heterogeneous mass lesion in the deltoid muscle. Needle biopsy was performed, and histological examination revealed poorly differentiated metastatic adenocarcinoma. Chest X-rays and a CT scan showed tumor in the right lung lobe. The patient underwent chemotherapy but died after 9 days because of pneumonia. Skeletal muscles are rare metastatic sites, even though muscles account for 40% of the total body weight. In this case, cancer cells might adhere to the muscle easily in blood borne metastasis because of hematoma after injection therapy. One of the reasons why diagnosis was delayed was that conservative treatment was administered without suspecting the true diagnosis because the early symptoms of periarthritis scapulohumeralis resemble those of deltoid muscle metastasis. Metastatic tumors should be suspected when symptoms such as fever, local heat, and swelling occur. Enhanced MRI and needle biopsy were very useful for the diagnosis.抄録全体を表示PDF形式でダウンロード (663K) -
大江 健次郎, 松浦 恒明2009 年 33 巻 3 号 p. 847-850
発行日: 2009年
公開日: 2010/01/29
ジャーナル 認証ありLipoma is the most popular benign tumor that need to be distinguished from well-differentiated liposarcoma. We had a case with large lipoma at the deep layer under deltoid muscle on proximal of humerus, and made resection. We discussed the surgical approach for that lesion. [case] 58 years old, male. 5 years ago he noticed a mass about his right shoulder, he came to our hospital because it gradually enlarged. An elastic-hard mass anterior right shoulder, enlarged with abduction. X-ray imaging had no abnormality. MRI revealed a mass, about 5 x 10 x 9 cm, with clear border, T1/T2 high/high intensity, homogeneous pattern just like adipose tissue. It grew so slowly that we diagnosed lipoma, made marginal resection with division of deltoid muscle longitudinally. The pathological diagnosis was lipoma. Generally, large sized soft tissue tumors may have malignancy. In this case, benign lipoma was most suspected with MRI, the physical course. But because the size was large, well-differentiated liposarcoma was possible. The surgical approach for tumor should be the shortest distance, so we performed an operation with longitudinal division of the deltoid muscle. But if lipoma is strongly suspected with imaging or the physical course, we should approach the mass inverting deltoid muscle to avoid axial nerve injury.抄録全体を表示PDF形式でダウンロード (532K) -
宇井 通雅, 小川 清久, 吉田 篤, 池上 博泰, 井口 理2009 年 33 巻 3 号 p. 851-854
発行日: 2009年
公開日: 2010/01/29
ジャーナル 認証ありSubdeltoid lipomas are not uncommon and usually asymptomatic. We presented an unusual case of subdeltoid lipoma associated with symptoms of glenohumeral instability and subacromial impingement. A 38-year-old man complained of a feeling of snapping or propping accompanied by dull pain at his left shoulder. External rotation with contraction of the deltoid or active abduction of the shoulder could produce dull pain like a subacromial impingement. MRIs revealed large subdeltoid mass and also showed a high intensity lesion beneath the acromion that indicated inflammation of the subacromial space. Mass was extirpated using the wide delto-pectoral approach.
Deep soft-tissue lipomas most frequently occured in patients 30-60 years old. Associated clinical symptoms were uncommon but included local pain, tenderness, limitation of range of motion, and nerve compression. Concerning the shoulder, the report of Rohrbough & Jobe was the only one that presented the clinical symptom of glenohumeral instability, and also Relwani's report was the only one that presented impingement syndrome caused by the lipoma. We had a case of subdeltoid lipoma associated with the symptoms of glenohumeral instability and subacromial impingement. To our knowledge this case was the 1st such reported. The middle 1/3 of the deltoid is a multipinnate muscle that is heavily collagenated. In our case, the sensation of instability would be produced by lipoma sliding forward beneath this thick intermediate deltoid muscle when it contracted with external rotation. And impingement would be produced by lipoma being pushed upward and compressing the subacromial bursa into the subacromial space. Subdeltoid lipoma, although extremely rare, could cause symptoms of glenohumeral instability and/or subacromial impingement. MRI was very useful to identify lipomas, but they have possibilities to be overlooked. MRI should be read by not only radiologist but also surgeons who know the patient's clinical appearances well.抄録全体を表示PDF形式でダウンロード (459K) -
月山 国明, 伊藤 陽一, 中尾 佳裕, 間中 智哉, 仲 哲史, 坂口 公一, 松本 一伸, 中村 信之, 鞆 浩康, 高岡 邦夫2009 年 33 巻 3 号 p. 855-857
発行日: 2009年
公開日: 2010/01/29
ジャーナル 認証ありWe described a case of arthroscopically treated ganglion arisen from acromio-clavicle (AC) joint. Case: A 73-year-old man had elevation difficulties of his left shoulder for 5 years without any treatment. He came to our shoulder clinic with discomfort and oppressive pain from lump beside his left AC joint. Active motion was restricted to 120 degrees in flexion, 100 degrees in abduction. Radiographic evaluation revealed osteoarthritis changes at the AC joint; MRI showed 40 × 30 × 20mm cyst above the AC joint with massive rotator cuff tears involved in the SSP and ISP tendons. Needle aspiration confirmed that cyst was ganglion with temporary shrinkage for 2 weeks. Arthroscopic surgery was performed because of consistent symptom of ganglion. Arthroscopic evaluation confirmed that ganglion had connection with AC joint and arthroscopic ganglion resection accompanied with distal clavicle resection was performed. Shoulder symptoms were completely disappeared in a short time postoperatively and active motion reached 150 degrees in flexion and 150 degrees in abduction. This ganglion originated from AC joint and arthroscopic distal clavicle resection was thought to be an effective minimally invasive surgery for complete destruction of AC joint.抄録全体を表示PDF形式でダウンロード (405K) -
福田 雅, 三宅 智, 長縄 敏毅, 山中 一輝, 寺林 伸夫2009 年 33 巻 3 号 p. 859-861
発行日: 2009年
公開日: 2010/01/29
ジャーナル 認証ありRecently, there are some reports of arthroscopic treatment for snapping scapula. We presented snapping scapula with twice arthroscopic treatment. [Case] A 21-year-old woman. She noticed snapping of her left scapula as a flag-bearer of her high school's marching band at the age of 16. Since then, flexion or abduction of her left shoulder within the range of 80-90 degrees caused painful snapping. Imaging studies did not demonstrate any deformity or tumor of the scapula, but incongruity between the scapula and the chest wall was detected by an MRI. To improve the functional disability of the scapulothracic joint, she received conservative therapy. She did not respond to conservative treatment and she felt dysesthesia of the upper extremities like a thoracic outlet syndrome.She underwent arthrosopic bursectomy at the age of 19. The operation finding was mild bursitis. Snapping was relieved by the surgery. 2 months later, when she tried to lift a heavy box, she felt ripping sensation within the scapulothracic joint and painful snapping relapsed. At the age of 21, an ultrasonography showed a nodule which seemed to be involved with snapping. Therefore arthroscopic surgery was performed again. The scapulothracic joint was covered with white scaring tissue which we removed. We also resected the bone edge surrounding superomedial angle of the scapula. The pathological finding of scaring tissue was scattered elastic fibers characteristic of elastofibroma, pseudo-tumor thought to be the result of mechanical stimulations under some genetic background. This case was guessed to be the state on the way to elastofibroma. 6 months after the surgery, she retuned to her school with the symptoms relieved. Arthroscopic treatment was effective for this snapping scapula. However, we think that more clearly defined indications for and contraindications against surgery are required.This case suggests that snapping scapula is a stimulator of elastofibroma formation.抄録全体を表示PDF形式でダウンロード (282K)