肩関節

変性疾患

肩石灰性腱板炎手術症例の臨床的特徴

高橋憲正, 菅谷啓之, 萩原嘉廣, 河合伸昭, 柴原基, 戸野塚久紘, 立原久義, 寺林伸夫, 森石丈二

2010 年 34 巻 2 号 p. 499-502
発行日: 2010年
公開日: 2010/09/03

DOIhttps://doi.org/10.11296/katakansetsu.34.499

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The purpose of this study was to analyze the clinical outcome of arthroscopic surgery for calcific tendinitis of the shoulder. Forty-one patients with a mean age of 55.2 years, enrolled in this study were available for follow-up. ASD was performed in 78% of the cases and all patients underwent rotator cuff repair after removal of the calcific tissue. JOA score and range of motion were assessed pre-and postoperatively. The location of calcification was investigated by using 3DCT. In order to show the location of calcification, the subacromial space was divided into nine areas including the footprint of the rotator cuff and the upper surface of the humeral head. All patients showed the positive impingement sign. JOA score was significantly improved from 74.4 ± 10.4 preoperatively to 97.3 ± 2.3 at final follow-up. Preoperatively, ranges of motion were significantly restricted in forward flexion, external rotation and internal rotation compared to the contra-lateral side. The motions in forward flexion and internal rotation were significantly increased at the time of follow-up. Calcification was observed in the centre-lateral area (area X) in 91% of the cases. In this study, characteristic clinical features were observed preoperatively, including the impingement sign, motion loss with pain at internal rotation at 90° abduction and the incidence of calcification in area X. These symptoms were improved after arthroscopic surgery including ASD, removal of calcific tissue and cuff repair.

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変形性肩鎖関節症における画像評価

間中智哉, 伊藤陽一, 松本一伸, 大戎直人, 中村信之, 中村博亮

2010 年 34 巻 2 号 p. 503-506
発行日: 2010年
公開日: 2010/09/03

DOIhttps://doi.org/10.11296/katakansetsu.34.503

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In decision making of surgical treatment for painful acromioclavicular (AC) joint osteoarthritis, image evaluation of AC joint is essential. The purpose of this study was to evaluate AC joint by X-ray and MRI images and to introduce new classification of these images. We retrospectively evaluated 40 shoulders of 38 patients (23 male, 15 female), who had arthroscopic distal clavicle resection under the diagnosis of degenerative AC joint osteoarthritis. Average age at the time of surgery was 60.1 years. X-ray images were assessed by the following 3 items: joint space narrowing, osteophyte formation and osteosclerotic change. MRI images were assessed by the following 3 items: joint fluid formation, distal clavicular bony marrow edema and acromional bony marrow edema. Each item was scored 1 point and total assessment was scored 6 points in total based on this new image classification. X-ray images evaluation revealed joint space narrowing in 27 shoulders (67.5%), osteophyte formation in 28 shoulders (70%) and osteosclerotic change in 20 shoulders (50%). MRI images evaluation revealed joint fluid formation in 33 shoulders (82.5%), distal clavicular bony marrow edema in 22 shoulders (55%) and acromional bony marrow edema in 22 shoulders (55%). Average total score was 3.8 points; joint space narrowing, joint fluid formation, distal clavicular bony marrow edema, and acromional bony marrow edema were significantly related to the severity of image evaluation. Our results showed that this new image classification of AC joint is helpful for the severity evaluation of the painful AC joint osteoarthritis.

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腫瘍

上腕骨近位部悪性骨腫瘍の人工骨頭置換術における軟部組織再建

関康弘, 中川照彦, 若林良明, 四宮謙一

2010 年 34 巻 2 号 p. 507-510
発行日: 2010年
公開日: 2010/09/03

DOIhttps://doi.org/10.11296/katakansetsu.34.507

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Malignant tumors in proximal humeri are often experienced. However, these cases are much fewer than benign ones such as usual fracture or arthritis. This article describes our surgical technique for malignant humeral tumor and the results after surgery. The cases were two males and one female (total 3 shoulders). The ages are between 11 and 50 years old (mean25.3). These cases consist of two osteosarcomas and one bone malignant fibrous histiocytoma(MFH) ,and observation periods were at the range of 18 to 40 months(mean 27). Surgical method: After chemotherapy, tumors covered with some muscles were excised. Rotator cuff and joint capsule were cut at the glenohumeral joint level and most deltoid muscles were removed. Then, after long prosthesises were inserted, artificial meshes were utilized to make the new joints stabilized. Quick-DASH and JOA score were 9.1 and 59.3 respectively. One shoulder showed subluxation inferiorly and all shoulders were not able to work enough by themselves spontaneously. Malignant bone tumor is a very specific disease. Therefore, patients might make the function less important compared with the recurrence of the tumor. However, shoulder dislocation should be prevented and this mesh graft seems to be quite useful for that. Next step is to acquire active movement of the new shoulder joint and muscular flap might be necessary for the achievement of that.

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その他

投球障害肩における Bennett 骨棘の 3DCT による評価

武長徹也, 杉本勝正, 大藪直子, 土屋篤志, 吉田雅人, 後藤英之, 大塚隆信

2010 年 34 巻 2 号 p. 511-514
発行日: 2010年
公開日: 2010/09/03

DOIhttps://doi.org/10.11296/katakansetsu.34.511

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The present study uses three-dimensional computed tomography (3DCT) to analyze the location and size of the Bennett lesion in 9 right and 2 left shoulders of 11 baseball players (average age, 26.1 y; range, 16 to 32 y) with posterior shoulder pain during throwing. Bennett lesions were located from the 6:30 to the 8:30 position of the glenoid. The mean length of the lesions was 20.3 mm and the mean cranial, center and caudal widths were 4.3, 9.1 and 6.8 mm, respectively. The mean cranial, center and caudal distances from the edge of the glenoid were 2.0, 1.5 and 2.9 mm, respectively and the mean thickness of the lesions were 1.8, 6.5 and 4.2 mm, respectively. Our previous anatomical examination of the posteroinferior part of the glenoid revealed that the triceps long head originated from the 7:30 to the 9 o'clock position of the glenoid, its width was 2-3 cm, and the posterior capsule was attached to the glenoid rim with the labrum. These findings indicated that the Bennett lesion was located closer to the triceps long head than to the posterior capsule and supported our hypothesis that the Bennett lesion is an avulsion fracture of the triceps long head or of the traction spur of the triceps long head.

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潜在性不安定症を伴う overhead-throwing athletes に対する鏡視下シュリンケージの成績

西尾悠介, 末永直樹, 大泉尚美, 船越忠直, 三浪明男

2010 年 34 巻 2 号 p. 515-518
発行日: 2010年
公開日: 2010/09/03

DOIhttps://doi.org/10.11296/katakansetsu.34.515

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Although several reports showed poor results of thermal shrinkage for shoulder dislocation, the effect of thermal shrinkage on overhead-throwing athletes with microinstability has been uncertain. The purpose of this study was to evaluate the efficacy of capsular shrinkage for overhead-thrower's shoulder with microinstability. Fourteen thrower's shoulders were divided into two groups as the follows; 7 shoulders without microinstability were treated by the conventional procedures for the throwing injuries without arthroscopic capsular shrinkage (the NS group), and 7 shoulders with microinstability were treated by the same procedures with capsular shrinkage (the CS group). In this study, microinstability was difined as relocation test positive. Mean follow up period was 4.3 years (1.5-9) by a modified Reinold's questionnaire. The age of the CS and NS groups was 26.4 ± 8.2 years (mean ± SD) and 29.6 ± 11.6 years (mean ± SD), respectively. In both groups, all cases returned to the same competitive level. Mean time to return to competition was 11 months (5-24) in the CS group and 9.4 months (2-24) in the NS group. Each parameter in the questionnaire were no obvious differences between the CS and NS group. However, there was one unsatisfactory case, a baseball pitcher, in each group because of joint contracture in the CS group and joint instability in the NS group. The result obtained here indicated that arthroscopic capsular shrinkage would be effective for microinstability in throwing athletes. Middle aged-athletes may have a risk for contracture after this procedure.

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投球スポーツにおける腱板，肩甲骨機能の低下と胸鎖関節の mobility との関係 - 胸鎖関節 mobility テストを用いて -

藤井康成, 小倉雅, 東郷泰久, 栫博則

2010 年 34 巻 2 号 p. 519-522
発行日: 2010年
公開日: 2010/09/03

DOIhttps://doi.org/10.11296/katakansetsu.34.519

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The aim of this study is to show the relationship between the rotator cuff and scapular dysfunction and the restriction of the sternoclavicular joint movement in throwing athletes. We studied 40 throwing athletes (throwing group, average age: 18.1 years) and 40 non-throwing athletes (non-throwing group, average age: 18.3 years) to evaluate the rotator cuff and scapular function with the elbow extension test (ET) and punching test (PT), and the sternoclavicular joint movement with the sternoclavicular joint mobility test (SCMT). The SCMT is a method to evaluate the sternoclavicular joint movement through indirect observation of the movement of examiner's fingers put on the proximal end of the bilateral claviculas during anterior elevation of bilateral shoulders from an at side position to the maximum. In normal cases, the bilateral proximal ends of the clavicula equally moved to the supero-lateral direction, rotating backward during elevation. We considered the SCMT positive when there was little movement of the clavicula at the throwing side, compared with that at the non-throwing side. We compared the positive ratio of the SCMT, ET, and PT between two groups. In the throwing group, the positive ratio of the SCMT, ET, and PT was 85, 92, 93%, respectively, while in the non-throwing group, that was 18, 20, 20%, respectively. There were significant differences between the two groups in each 3 test. Irrespective of the two groups, cases with a positive SCMT almost always corresponded to cases with a positive ET and PT. The restriction of the sternoclavicular joint movement greatly influenced the rotator cuff and scapular dysfunction in throwing athletes.

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原テストによる少年野球選手の肩評価 ‐下肢柔軟性との関連‐

土屋篤志, 吉田雅人, 大藪直子, 後藤英之, 武長徹也, 冨田眞壽生, 杉本勝正

2010 年 34 巻 2 号 p. 523-526
発行日: 2010年
公開日: 2010/09/03

DOIhttps://doi.org/10.11296/katakansetsu.34.523

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We evaluated baseball players in little league at medical screening including examination of the shoulder joint and flexibility of the lower extremities.
In this study, 58 baseball players in little league were evaluated from 2004 to 2006. The mean age of subjects was 11.3 years old ranging from 9 to 12. At medical screening, a specific medical examination of the shoulder joint proposed by Hara and test of flexibility were performed on each subject. A flexibility test for the hamstrings, quadriceps, iliopsoas, spine and hip joint was performed and scored (total 12 point). The players who had elbow or shoulder pain were classified as injury group and those without pain were classified as non-injury group.
There were 8 players in the injury group. The average of shoulder scores (total 11 points) for the throwing side by a specific shoulder test were 6.3 points for the injury group and 8.4 points for the non-injury group and those for the non-throwing side were 7.9 points and 8.6 points respectively. The average of flexibility scores was 6.0 points for the injury group and 7.4 points for non-injury group respectively. There was no correlation between the total shoulder scores and the total flexibility scores. However, in the injury group, most of the shoulder and flexibility scores were less than 7 points and 8 points respectively. The specific test for shoulder joint and flexibility test were useful for detecting not only shoulder joint problems but also potential elbow joint injury.

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治療法

Cuff tear arthropathy に対する人工骨頭置換術と広背筋移行術の成績

船越忠直, 末永直樹, 大泉尚美, 山根慎太郎, 三浪明男

2010 年 34 巻 2 号 p. 527-530
発行日: 2010年
公開日: 2010/09/03

DOIhttps://doi.org/10.11296/katakansetsu.34.527

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Twenty-six patients underwent humeral head replacement (HHR) with or without tendon transfer for cuff tear arthropathy. There were 8 men and 18 women. The mean age was 70.1 years (58 to 81 years). Superior approach was used for the preservation of the coracoacromial arch and intact subscaplaris tendon. The smallest humeral head was selected for the possibility of rotator cuff repair. However, when rotator cuff remained in irreparable condition, latissimus dorsi tendon or pectoralis major tendon was transferred for cuff reconstruction. The patients were divided by 2 groups; 14 shoulders of HHR without tendon transfer and 12 shoulders of HHR with tendon transfer. Each patient was evaluated with Japan Orthopaedic Association score and Neer's limited goals rating scale after a least 1 year of follow up. Thirteen patients were rated as successful and one as unsuccessful in the HHR without tendon transfer group. On the other hand, 10 patients were rated as successful and 2 as unsuccessful in the HHR with tendon transfer group. Postoperative active flexion in both groups statistically improved compared to preoperative active flexion. Although postoperative external rotation in the HHR with tendon transfer group improved compared to preoperative one, there was no significant difference of external rotation in the HHR group between pre and postoperative evaluation. There was no obvious nerve injury or deep infection. Temporary inferior subluxation was found in the HHR with tendon transfer group. The radiographic evaluation showed one case of glenoid erosion. The current results were consistent with the prior studies. Tendon transfer restored active external rotation but the results were imcomplete and variable. Improvement was better in case of severe preoperative active external rotation. Further study should be conducted on this point.

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高齢者の Cuff Tear Arthropathy に対する CTA 人工骨頭置換術の経験

桜井悟良, 酒本佳洋, 水掫貴満, 仲川喜之, 橋内智尚

2010 年 34 巻 2 号 p. 531-534
発行日: 2010年
公開日: 2010/09/03

DOIhttps://doi.org/10.11296/katakansetsu.34.531

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The purpose of this study was to evaluate the clinical outcome after CTA head hemiarthroplasty has been performed on older patients of cuff tear arthropathy. From 2006, six patients with cuff tear arthropathy, without superior humeral escape (Seebauer IA, 3 cases and IIA, 3 cases) were treated with CTA head hemiarthroplasty. There were 1 male and 5 females. The average age at the time of surgery was 75.5 years (ranged 64-88 years). Depuy Global Advantage CTA head was used in 5 cases and Biomet Bio-Modular EAS head was used in one case. All prosthesis were non-cemented types. Patients were evaluated based on JOA scores, range of motion, and X-P. Patient follow-up averaged 25.3 months (ranged 12-36 months). Patients showed significant improvement in JOA score (32.2 to 68.2), pain score (6 to 19), function (7 to 12), forward flexion (29 degrees to 89 degrees) and external rotation (27 degrees to 45 degrees). All patients were satisfied with diminished pain, but still had some problems in ADL. There was no hardware loosening or acromion wear. CTA head hemiarthroplasty appears to provide reasonable short-term results for older patients of cuff tear arthropathy. However, hemiarthroplasty with muscle transfer or the reverse arthroplasty remains the treatment of choice for functional recovery.

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肩関節鏡視下手術中の脳血流，脳波の検討
－体位による比較－

梶田幸宏, 岩堀裕介, 加藤真, 佐藤啓二

2010 年 34 巻 2 号 p. 535-537
発行日: 2010年
公開日: 2010/09/03

DOIhttps://doi.org/10.11296/katakansetsu.34.535

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The purpose of this study was to investigate whether a difference of surgical position affects cerebral circulation and electrical activity. 19 patients were evaluated. 10 cases with rotator cuff injury underwent arthroscopic rotator cuff repair in beach chair position (BCP), and 9 cases with shoulder anterior instability underwent arthroscopic Bankart repair in lateral decubitus position (LP). Average age of 48.3 years (19-74years) in the BCP group was significantly older than that of 31.6years (16-54years) in the LP group. No significant differences were found in other demographies between the two groups. The change of blood pressure (BP), heart rate (HR), regional cerebral oxygen saturation (rSO₂) and spectral edge frequency 95 (SEF95) were measured before and after postural change. In the BCP group Systolic BP, rSO₂ and SEF95 significantly decreased. Whereas no significant changes of cerebral circulation and electrical activity were observed in the LP group. No apparent complication associated with postural change was experienced either group. This study suggested that BCP caused subclinical changes of cerebral circulation and brain activity, which was not observed in LP.

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腱板広範囲断裂に対する鏡視下デブリドマンの治療成績

杉原隆之

2010 年 34 巻 2 号 p. 539-542
発行日: 2010年
公開日: 2010/09/03

DOIhttps://doi.org/10.11296/katakansetsu.34.539

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We have treated elderly patients with irreparable massive rotator cuff tears by arthroscopic debridement. The purpose of this study was to evaluate the clinical results of the arthroscopic debridement for massive rotator cuff tears. Seven shoulders with irreparable massive rotator cuff tears were treated by arthroscopic debridement from 2000 to 2009. There were 3 males and 4 females with an average age of 69.0 years old. There were 5 right sides and 2 left sides. They were followed up for 9 months to 115 months (average 40.3 months). The pre and post-operative results were evaluated according to the shoulder evaluation sheet of the Japanese Orthopaedic Association (JOA score). The average preoperative JOA score was 65.0 points and the average postoperative JOA score was 93.8 points. The average postoperative JOA score improved compared with the preoperative JOA score statistically. The average preoperative JOA pain score was 7.9 points and the average postoperative JOA pain score was 28.6 points. The average preoperative JOA function score was 13.0 points and the average postoperative JOA function score was 18.8 points. The average preoperative JOA ROM score was 26.1 points and the average postoperative JOA ROM score was 28.4 points. Each average postoperative JOA score improved compared with the preoperative JOA score. The clinical results of arthroscopic debridement for massive rotator cuff tears were mostly good.

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症例報告

鏡視下手術を施行した関節窩骨折を伴う肩関節後方不安定症の一例

守重昌彦, 岩噌弘志, 榊原精一郎

2010 年 34 巻 2 号 p. 543-546
発行日: 2010年
公開日: 2010/09/03

DOIhttps://doi.org/10.11296/katakansetsu.34.543

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Posterior shoulder instability with bony lesions is uncommon. We experienced a patient with this disorder and applied an arthroscopic procedure. A-16-year-old male suffered shoulder subluxation due to an anterior direct blow to his shoulder in 90° abduction while training for American football. Despite the injury, he immediately returned to training. He suffered a similar injury 6months later, and was thus unable to continue training due to recurrent subluxation,and he visited our hospital. We identified posterior instability of his shoulder by the load and shift test and the posterior jerk test. X-rays and CT showed a posterior glenoid rim fracture which was approximately 20% of the width of the glenoid cavity in size. MRI revealed postrerior labrum detachment from the glenoid with the rim fragment. Anterior components were intact. We considered the fragment to be a posterior osseous Bankart lesion, and performed arthroscopic osseous Bankart repair. We threaded the labrum with the fragment, and fastened it using suture anchors. A sling was used for 3 weeks after surgery. After confirmation of the union by CT, we allowed him to return to playing football. At present, he participates in several sports without anxiety. The JSS shoulder instability score improved from 55 points to 92 points. We describe herein arthroscopic treatment for posterior shoulder instability with a large rim fragment and our patient's good short-term results.

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肩甲窩骨折の鏡視下骨接合術に METREx ダイレーターを応用した 1 例

栗山新一, 井上悟史

2010 年 34 巻 2 号 p. 547-550
発行日: 2010年
公開日: 2010/09/03

DOIhttps://doi.org/10.11296/katakansetsu.34.547

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For treatment of a large anterior glenoid fracture, we present a comparatively easy and unique technique for arthroscopic reduction and internal screw fixation. A 75-year-old woman fell down in a motorcycle accident. The patient felt dislocation and spontaneous reduction of her shoulder. Plane radiograph films showed anterior glenoid fracture with displaced bone fragment. The fragment size measured 35% of the glenoid length by 3DCT images. Fifteen days after the injury the patient was admitted for arthroscopy. The procedure was performed in the beach chair position. The image intensifier was positioned cranially. The arthroscope was introduced through the posterior portal. Mobilization and reduction of the glenoid fragment was performed through the antero-superior portal. In the use of an antero-inferior transsubscapularis approach we applied dilators of METRx MicroDiscectomy System (Medtronic SOFAMOR DANEC). First, a 1.2mm K-wire was inserted through the subscapularis percutaneously and first and second dilators were inserted over the K-wire. Next, the second dilator was removed, then a 7.0mm smooth cannular(Smith & Nephew) in the same diameter as the second dilator was replaced. For fragment fixation TORX 3.0mm cannulated and self-tapping screw (Meira) was used through the cannular. She got bone union in three months after the operation. There were no complications with the operation. We introduce a little contrivance of arthroscopic reduction and internal fixation for an anterior glenoid fracture this time. This method is effective because of being a comparatively easy, safe and minimally invasive surgery.

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肩甲骨関節窩骨折に対して関節鏡を併用して内固定を行った 2 症例

前原孝

2010 年 34 巻 2 号 p. 551-555
発行日: 2010年
公開日: 2010/09/03

DOIhttps://doi.org/10.11296/katakansetsu.34.551

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We experienced two cases of the glenoid fracture treated by the internal fixation with the arthroscopic assistance.
The first case was a 27-year-old man. He fell 3 meters to the ground and suffered Type 3 glenoid fracture in Ideberg classification. The operation was performed in a lateral position. We inserted two K-wires into the coracoid process, and reduced an angular deformity of the glenoid surface using the joy-stick technique. Then, a cannulated screw was inserted from the coracoid process to the glenoid. The reduction and fixation were assessed with arthroscope, and they were acceptable. The clinical result was satisfactory (98 points in JOA score).
The second case was a 21-year-old man. He fell 2 meters to the ground and suffered the glenoid fracture combined Type 2 and 3. The glenoid was broken into two fragments, and they showed an angular deformity about 80 degrees. The operation was performed in a beach-chair position, using posterior elevation position subdeltoid approach (Brodsky approach) with the arthroscopic assistance. We could minimize the detatchment of deltoid muscle by elevating the upper extremity and could perform the internal fixation less invasively, using the arthroscope, without cutting the joint capsule. The clinical result was also satisfactory (96 points in JOA).
For a transverse fracture of the glenoid, the joy stick technique was useful for the superior fragment. Brodsky approach was also useful to reduce and fix the inferior fragment. Furthermore, the arthroscopic assistance was very valuable to evaluate the reduction of the joint surface, and the handling of the image intensifier was very important.

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誘因なく急速に上腕骨頭の破壊をきたした１例

吉川勝久, 玉井和哉, 矢野雄一郎, 野原裕

2010 年 34 巻 2 号 p. 557-560
発行日: 2010年
公開日: 2010/09/03

DOIhttps://doi.org/10.11296/katakansetsu.34.557

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We report a patient with spontaneous rapid destruction of the humeral head mimicking femoral head destruction in rapidly destructive coxopathy. A 78-year-old woman developed pain in her right shoulder and visited an orthopedist in August 2008. Infectious arthritis was denied and the patient was given an intra-articular corticosteroid injection and oral NSAIDs. However, the shoulder pain persisted, resulting in humeral head destruction on the follow-up x-ray. She was referred to us in November 2008. She reported a history of diabetes, hypertension and osteoporosis but no history of oral corticosteroid use or alcohol drinking. On examination, she reported tenderness over the anterior and posterior aspect of the right shoulder, and the acitve range of the motions were limited in flexion and external and internal rotations. Neurological findings were intact. Blood test did not reveal inflammation, while urine test revealed a slight increase in deoxypyridinoline. X-ray showed significant humeral head collapse and glenoid degeneration. MRI revealed that the rotator cuff was preserved. Since infection or neuropathic diseases were unlikely, the patient underwent total shoulder arthroplasty. Operative findings revealed that the articular cartilage of the humeral head and of the glenoid had disappreared, associated with eburnation of the subchondral bone. Histological findings revealed that the humeral head was not extensively necrotic, but rather included new bone repair as in fracture. The postoperative course was unremarkable. It has been indicated that insuficency fracture precedes rapidly destructive coxopathy in the elderly . We believe that a similar process may have caused rapid destruction of the shoulder in this case.

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関節鏡を用いた化膿性肩関節炎の治療経験

安井謙二, 加藤義治, 神戸克明, 菅谷啓之

2010 年 34 巻 2 号 p. 561-564
発行日: 2010年
公開日: 2010/09/03

DOIhttps://doi.org/10.11296/katakansetsu.34.561

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We treated 3 cases with severe septic arthritis of the shoulder joint in our hospital. All the cases were treated by arthroscopic debridement, insertion of the Penrose drain, intravenous administration of antibiotics and early motion exercise just after the operation. Case 1 was a 61-year-old woman who had taken an immunosuppressive drug for a kidney transplantation. The follow up period was 10 months and the postoperative JOA score was 84 points. Case 2 was a 60-year-old woman who had no predisposing factor, but a merged iliopsoas muscle abscess. The follow up period was 11 months and the postoperative JOA score was 92 points. Case 3 was a-71-year-old woman who had been a haemodialysis patient. The follow up period was 4 months and the postoperative JOA score was 94 points. Recurrence of the infection did not occur in any case. The treatment of severe septic arthritis of the shoulder joint needs the improvement of the inflammatory reaction and good function without contracture. Arthroscopic procedure is more thorough, less invasive, and less painful than open treatment, therefore all the cases could perform early motion exercise. As for the open drainage with Penrose drain, management was simple, and the rehabilitation was easy. Motion exercise in itself produced drainage effects and promoted nourishment of cartilage and prevented the intraarticular adhesion. Our procedures were more effective and a less invasive treatment than open treatment, so they had better function without contracture.

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肩甲上神経に発生した神経鞘腫の一例

栫博則, 藤井康成

2010 年 34 巻 2 号 p. 565-567
発行日: 2010年
公開日: 2010/09/03

DOIhttps://doi.org/10.11296/katakansetsu.34.565

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Suprascapular neuropathy due to sports or ganglion is well described, whereas schwannoma involving the suprascapular nerve is relatively rare.
We present a case of schwannoma involving the suprascapular nerve.
The patient is a 14-year old male. His chief complaint is right shoulder pain. He had concervative therapy, but shoulder pain continued. So he visited our hospital. His range of motion and manual muscle test of the right shoulder are within normal limits. He complained of right shoulder pain in horizontal extension. MRI identified a well-circumscribed lesion which shows iso intensity in T1 sequences and high intensity in T2 sequences in the spinoglenoid notch. MRI with gadolinium contrast revealed a mass in the spinoglenoid notch with contrast enhancement and a central area of necrosis. Electromyogram and nerve conduction velocity showed neurogenic pattern. We diagnosed neoplastic lesions involving the suprascapular nerve and resected it by open procedure. The pathological diagnosis was schwannoma.

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