肩関節
Online ISSN : 1881-6363
Print ISSN : 0910-4461
ISSN-L : 0910-4461
34 巻, 3 号
選択された号の論文の93件中1~50を表示しています
解剖
  • 落合 信靖, 佐藤 進一, 杉岡 佳織, 見目 智紀, 西須 孝, 藤田 耕司, 松木 圭介
    2010 年 34 巻 3 号 p. 569-573
    発行日: 2010年
    公開日: 2010/11/16
    ジャーナル 認証あり
    The mechanism of lateral side of the shoulder pain due to the shoulder pathology was not clarified. The purpose of this study was to evaluate the dorsal root ganglion (DRG) neurons innervating the glenohumeral joint (GHJ), subacromial bursa (SAB) and lateral side of the shoulder. In this manner, dichotomizing axons projecting to the GHJ and lateral side of the shoulder (LS), SAB and LS were also evaluated. Two kinds of neurotracers, dioctadecyl-tetramethyl-indocarbocyanine-perchlorate (DiI) and fluoro-gold (FG), were used to detect the GHJ, SAB and LS separately. In the first group, FG was injected into the GHJ and DiI were injected into LS. In the second group, FG was injected into SAB and DiI were injected into LS. Seven days later, DRGs were harvested between C1 and T1. The number of FG labeled-neurons, DiI-labeled neurons and double-labeled neurons were counted respectively. DiI-labeled neurons which innervate LS were distributed from C2 to C7. FG-labeled neurons which innervate GHJ were distributed from C2 to C7 and FG-labeled neurons which innervate SAB were distributed from C2 to C8. DRG neurons which double-labeled with FG (GHJ) and DiI (LS) were 9.4% of FG-labeled neurons and DRG neurons which double-labeled with FG (SAB) and DiI (LS) were 17.1% of FG-labeled neurons. Dichotomizing axons projecting to the GHJ and LS, and SAB and LS induced the referred lateral side of the shoulder pain due to the shoulder pathology. It is also indicated that lateral side of the shoulder pain is stronger when the pathology involved SAB.
  • 高田 逸朗, 今谷 潤也, 清水 弘毅, 名越 充, 西田 圭一郎
    2010 年 34 巻 3 号 p. 575-578
    発行日: 2010年
    公開日: 2010/11/16
    ジャーナル 認証あり
    The deltoid split approach is usually used for intramedullary nailing or minimum invasive plate osteosynthesis for proximal humerus fractures. The risk of axillary nerve injury has been reported with this approach when the incision exceeds 5cm distal from the anterior corner of the acromion. We carried out a cadaveric study on the axillary nerve anatomy in order to determine a safety zone for the deltoid split approach. We dissected and observed how the axillary nerve runs beneath the deltoid muscles in twenty three embalmed cadavers. The average distance from the anterior corner of the acromion to the axillary nerve in the anterior raphe was 4.67cm. Only one branch of the axillary nerve was noted crossing the anterior raphe in all shoulders. After crossing the anterior raphe, the axillary nerve was found to enter from beneath the muscularis, between the muscularis layers and after that many branches of it spread medially and cephalad. It may be difficult in actual operations to directly observe the axillary nerve in the area from the entry point medial. The distance from the point that the axillary nerve crosses the anterior raphe to its entry point between the muscularis layers was sometimes very close. (less than 1cm) These findings indicated that special care must be taken not to injure the axillary nerve in splitting the deltoid muscle at the antero-medial area beyond the anterior corner of the acromion.
  • 後藤 英之, 堀内 統, 西森 康浩, 大塚 隆信, 杉本 勝正, 大藪 直子, 土屋 篤志, 吉田 雅人, 武長 徹也
    2010 年 34 巻 3 号 p. 579-582
    発行日: 2010年
    公開日: 2010/11/16
    ジャーナル 認証あり
    We evaluated the scapular insertion of the long head of the triceps tendon at the edge of the glenoid In this study, 16 cadaveric right shoulders (male 11 cases, female 5 cases) were evaluated for the macroscopic investigation. The mean age of the cases was 83.3 years old ranging from 57 to 102 years old. For the preparation, the long head of the triceps tendon was carefully dissected and the site, the size, and the shape of the insertion were recorded. The insertion site of the long head of the triceps was variable. It was located at 6:30 in 7 shoulders, at 6:00 in 6 shoulders, and at 5:30 or 7:00 or 7:30 in one shoulder. The mean length and width of the insertion were 20.3 (13-29) mm and 10.8 (5-15) mm, respectively. The distance of the insertion from the edge of the glenoid was 1.5 (0-6) mm. The shape of the insertion was classified into three types, triangle in 6 cases, spindle in 7 cases and oval in one case. The site and the shape of the scapular insertion of the long head of the triceps were variable. The variety of the insertion may have a relationship to the occurrence of Bennet's lesion in throwing athletes.
  • 小石 逸人, 菅本 一臣, 田中 誠人, 後藤 晃, 吉川 秀樹, 大森 康司
    2010 年 34 巻 3 号 p. 583-586
    発行日: 2010年
    公開日: 2010/11/16
    ジャーナル 認証あり
    Glenohumeral ligaments (GHLs) play important roles in stabilizing the shoulder joint. However, it is impossible to assess the kinematics of the GHLs in vivo. Here we estimated the length of GHLs using an in vivo motion analysis system and visualized the kinematics of each GHL. Firstly, 3D-CT data were collected from 10 enbalmed cadaver shoulders with marker pins inserted into the sites of attachment of superior, middle, anterior band of inferior GHL (SGHL, MGHL, AIGHL). The average positional data of each ligament was determined, based on the data related to the size of the humerus and glenoid.Secondly, 3D-MRI data of shoulder were collected from 10 healthy volunteers, in the position of every 30 degrees between maximal internal and external rotation at 90 degrees of abduction. Those data were matched to the cadaveric data and the pathways of each GHL during shoulder internal-external rotation were visualized with our motion analysing system.The estimated pathway of each GHL was visualized as quasi-dynamic motions by our system. The mean maximum length of SGHL was 26.2mm at 30 degrees of external rotation. The mean maximum length of MGHL and AIGHL were 40.3mm and 42.7mm, respectively, at maximal external rotation. We established a new visualization system of GHLs. The length of each GHL at various shoulder positions can be calculated by this system. We believe that this system has a potential to provide useful information to understand the kinematics of the shoulder joint.
  • 山口 久美子, 加藤 敦夫, 秋田 恵一, 望月 智之
    2010 年 34 巻 3 号 p. 587-589
    発行日: 2010年
    公開日: 2010/11/16
    ジャーナル 認証あり
    Coracohumeral ligament (CHL) is situated in the gap between the supraspinatus and the subscapuralis. There are only a few studies concerning the CHL after Clark and Harryman II (1992) in spite of the important role that fills the rotator interval. In this study, we dissected six shoulders of three cadavers to observe the spatial distribution of the CHL in detail. Four shoulders of two cadavers were processed to analyze the attachment of the rotator cuff and the capsule histologically. For the histological analyses, whole parts of the CHL were removed emblock, and serial sections were made from proximal to distal. In gross anatomy, the CHL attached to the proximal lateral surface of the coracoid process in its most proximal part. It filled the rotator interval between the supraspinatus and the subscapularis. Most distal part of the CHL extended to both the superior and inferior surfaces of supraspinatus, and both the anterior and posterior surfaces of subscapularis. In the rotator interval, CHL connected to the superior glenohumeral ligament (SGHL). There was no clear border between the CHL and the SGHL in either gross anatomy or histologically. Histologically, the CHL contained only fine loose slack collagen fibers without any dense fiber that is normally observed in a ligament. With flexion and the extension, the CHL were stretched to pull the rotator interval. From these observations, the CHL seems to work with the SGHL for the stability of the long head of the biceps during shoulder movement.
  • 高瀬 勝己, 山本 謙吾
    2010 年 34 巻 3 号 p. 591-594
    発行日: 2010年
    公開日: 2010/11/16
    ジャーナル 認証あり
    The treatment for acromioclavicular joint separations has focused on anatomic restoration of the coracoclavicular ligaments. We reviewed the detailed anatomy of trapezoid ligaments and conoid ligaments using cadavers. The subjects were 40 shoulders of the 20 cadavers. We investigated the distributed direction and attachment sites of both trapezoid and conoid ligaments. The trapezoid ligaments began at about 2 cm away from the central point of the distal coracoid process and directed toward the undersurface of the clavicle. The attachments extended from 13 to 26 mm in sagittal dimension and from 13 to 15 mm in coronal dimension. The conoid ligaments began at the medial posterior margin of the coracoid process and directed toward to the conoid tubercle in the clavicle. The attachments extended from 15 to 30 mm in sagittal dimension and from 3 to 6 mm in coronal dimension. The findings are important indices for the accurate reconstruction of the coracoclavicular ligaments in acromioclavicular joint separations.
機能
  • 矢野 雄一郎, 玉井 和哉, 野原 裕, 浜田 純一郎, 吉崎 邦夫, 佐原 亮, 遠藤 和博, 五十嵐 絵美
    2010 年 34 巻 3 号 p. 595-598
    発行日: 2010年
    公開日: 2010/11/16
    ジャーナル 認証あり
    When we lift our arm to the overhead position, we do not elevate it with elbow extension but we raise it with elbow flexion. Nevertheless, there have been few reports about the arm raising. On the other hand, the setting phase defined as below 30 degrees has been controversial, because some authors reported it as below 60 degrees. The purposes of this study were to compare shoulder motion between arm elevation and raising, and to identify the setting phase. 15 healthy subjects participated in this study. Reflecting markers were set up on the skin of the coracoid process, acromial angle, inferior angle, medial border of the scapular spine, elbow, and the spinous processes of T2, T7 and L5. A 3-D motion computerized analyzer (Mac 3D System) was used for collection of kinematics data. All subjects randomly elevated and raised their dominant and non-dominant arms 5 times on the scapular plane. Scapurohumeral rhythm (SHR) was calculated from GH-j motion angle / scapular motion angle. In addition, we calculated the coefficient of variation (CV) from standard deviation / average. We could not verify the static significance between elevation and raising. Values of CV varied and were below 50 degrees in elevation and below 60 degrees in raising. In addition, a similar phase was identified below 60 degrees on lowering. We could not find any static significance between the shoulder motion of arm elevation and raising according to 3-D analysis. The setting phase was identified as below 60 degrees on arm elevation, and 50 degrees on arm raising.
  • 仲川 春彦, 森原 徹, 立入 久和, 佐々木 健太朗, 木田 圭重, 岩田 圭生, 堀井 基行, 久保 俊一, 黒川 正夫
    2010 年 34 巻 3 号 p. 599-603
    発行日: 2010年
    公開日: 2010/11/16
    ジャーナル 認証あり
    The purpose of this study was to quantify, with integrated electromyograms(EMG), the activities of supraspinatus(SSP) and infraspinatus(ISP) muscles during various activities of daily living(ADLs) under the abduction orthosis, and to provide precaution guidance of ADLs for patients in the early postoperative period of rotator cuff repair.
    Five asymptomatic women, aged 24 to 48 years old, volunteered to participate. Fine-wire(SSP) and surface(ISP) electrodes recorded the mean peak normalized(percent maximal voluntary contraction [%MVC]) EMG activity from each immobilized muscle during 16 various activities of daily living; washing the face, eating, drinking and so on.
    The SSP activity was high during wiping the face (54.6%MVC), washing the face (44.0%MVC), putting on glasses (30.0%MVC) and drinking from a glass (28.4%MVC). The ISP activity was high during squeezing a towel (67.6%MVC), eating with chopsticks (44.0%MVC) and brushing teeth (32.8%MVC). The activities of face cleaning, eating and drinking exceeded 20%MVC in the SSP and ISP. The activities which should be avoided in the early postoperative patient could be selected.
  • 佐々木 健太朗, 森原 徹, 岩田 圭生, 木田 圭重, 久保 俊一, 堀井 基行, 黒川 正夫
    2010 年 34 巻 3 号 p. 605-607
    発行日: 2010年
    公開日: 2010/11/16
    ジャーナル 認証あり
    The rotator cuff muscles are very important for the motions and the dynamic stabilization of the shoulder girdle. The purpose of this study was to analyze the inner muscle activity during shoulder flexion and abduction by using surface and fine wire electromyography (EMG). EMG activity was examined in 5 static positions from 0 degrees to 120 degrees for 5 seconds in each position during exercises of shoulder flexion and abduction. We evaluated supraspinatus muscle activity on Needle EMG and infraspinatus muscle on surface EMG. 6 healthy volunteers participated in the study. EMG data were collected for analysis during maximal voluntary isometric contraction and 3 repetitions of each exercise. We used Telemyo System 2400(Noraxon USA Inc) and analyzed by MyoVideo and MyoResearch. The relative activity of both supraspinatus and infraspinatus muscles gradually increased during abduction.
    The relative activity of infraspinatus muscle gradually increased during flexion. The relative activity of supraspinatus muscle at 90 degrees in flexion was less than at 60 degrees. This study shows that infraspinatus muscle has an important role in the dynamic stabilization, at 90 degree flexed position.
診察 • 診断
  • 石田 康行, 帖佐 悦男, 矢野 浩明, 崎濱 智美
    2010 年 34 巻 3 号 p. 609-611
    発行日: 2010年
    公開日: 2010/11/16
    ジャーナル 認証あり
    We perform belly press test and bear hug test as subscapularis(Ssc) clinical tests. We have the impression that their sensibility and specificity are high. We reviewed the relationship between these tests and arthroscopic findings. We evaluated 82 shoulders (62 males, 20 females) who had arthroscopic rotator cuff repair performed from May 2006 to May 2009. Their ages were from 32-78 years old ( average : 61.9 years old ). We performed belly press test and bear hug teat as the preoperative Ssc clinical tests. First 49 shoulders were evaluated by belly press test, next 33 shoulders were evaluated by bear hug test. We reviewed the relationship between Ssc clinical tests and arthroscopic findings. 28 shoulders were positive at belly press test. Arthroscopic findings showed 18 complete tears of Ssc, 2 partial tears of Ssc, 5 superior glenohumeral ligament (SGHL) injuries and 3 false positives (2 contractures and 1 palsy). 14 shoulders were positive at bear hug test. Arthroscopic findings showed 11 complete tears of Ssc, 2 partial tears of Ssc and 1 SGHL injury. 2 false negatives were found in each group. Positive judgement of the belly press test was more unclear than that of the bear hug test. So, false positive was found only in the belly press test.
    In this study, Belly press test and bear hug test had high sensibility and specificity. Bear hug test was a better Ssc clinical test, because its positive judgment was clear.
検査
  • 杉本 勝正, 後藤 英之, 吉田 雅人, 土屋 篤志, 武長 徹也
    2010 年 34 巻 3 号 p. 613-615
    発行日: 2010年
    公開日: 2010/11/16
    ジャーナル 認証あり
    In 2004, we reported the location of a Bennett lesion coincides with the origin of the triceps long head. We therefore considered that the triceps is more associated with a Bennett lesion than is the posterior capsule. So we thought it was important to check the origin of the triceps long head.
    The purpose of this study was to clarify the efficacy of Triceps Long head test (TL test) for throwing injury. We devised a TL test that is a stress test of the triceps long head. In the maximum horizontal flex position, the patient extend only the elbow joint. We thought that when the patient felt pain at that time, there was some inflamation or damage in the proximal end of the triceps long head. The subjects were 28 patients who consulted our clinic from, 2007 to 2008, because of throwing disturbance and were positive in the TL test. We investigated the triceps long head by ultrasonography(US) and checked their shoulder. 26 cases out of 28 had some damage in the proximal end of the triceps long head by US. TL test changed to negative from 1 week to 4 months in 24 cases, 4 patients had a constant pain, and 3 cases had Bennett lesion. 27 cases had GIRD(glenohumaral internal rotaion deficit). All 28 cases had a tenderness at the origin of the triceps long head.
    We made sure of the relation between TL test and the some damage of the triceps long head. TL test is useful for the diagnosis of posterior pain in throwing injury.
  • 中道 憲明, 松村 昇, 池上 博泰, 塩野 将平, 丹治 敦
    2010 年 34 巻 3 号 p. 617-620
    発行日: 2010年
    公開日: 2010/11/16
    ジャーナル 認証あり
    The purpose of this study is to evaluate the availability of the ten seconds test of the shoulder. We present the results of arthroscopic repair of the rotator cuff tears in 82 patients, (54 men and 28 women) totaling in 82 shoulders. The average age of the patients at the time of the operation was 60.2 years old (range, 30-78 years). All of the patients were observed for at least one year following the operation (average, 19.9 months; range, 6-48 months). The shoulders were evaluated with the rating scale of the Japanese Orthopaedic Association score (JOA score). Eleven tears were small (less than one centimeter in length), twenty nine were medium (one to three centimeters), twenty three were large (more than three to five centimeters), and nineteen were massive (more than five centimeters). An average of 2.4 (range, 1 to 4) suture anchors were used in repair. The active range of motion improved significantly after the procedure. The average total JOA score improved from 68.8 to 90.8 points. The average ten seconds test improved from 11.6 to 15.2 times. Arthroscopic repair of the rotator cuff tear produced satisfactory results. The arthroscopic method offers several advantages including small incisions, the lack of need for detachment of the deltoid, and less-tissue dissection. The ten seconds test and JOA score had recovered at one year after the operation. The ten seconds test of the shoulder is available for evaluating the shoulder function.
  • 小椋 明子, 森原 徹, 立入 久和, 木田 圭重, 堀井 基行, 久保 俊一, 黒川 正夫
    2010 年 34 巻 3 号 p. 621-623
    発行日: 2010年
    公開日: 2010/11/16
    ジャーナル 認証あり
    The glenohumeral joint (GHJ) capsule and surrounding bursae are important for the control of intra-joint fluid volume and pressure. The relationship between GHJ capsule and bursae was still unclear. The purpose of this study was to examine the kinematics (volume, morphology) of GHJ capsule and subscapular bursa (SSB) during shoulder internal and external rotation (IR, ER) by three dimensional computed tomography (3D-CT) reconstruction images after arthrograms. 6 patients with rotator cuff tear were enrolled in this study. All patients had CT (2-positions : IR, ER) examination after arthrograms. Reconstruction of 3D computer models for contrast medium, GHJ capsule, SSB and subacromial bursa (SAB) from the CT image in the 2 positions was done using a custom-made software program (Mimics, Materialise Inc, Ann Arbor, MI). By measuring the volume of each model, (GHJ capsule, SSB and SAB etc.) the morphology and volume between 2 positions were compared by paired T-test. The volume of SSB decreased at the ER position of shoulder. The volume of the GHJ capsule was maintained during the shoulder rotation. The capusle at the posterior region was stretched at the IR position, and shrunk at the ER position. On the external rotation of the rotator cuff tear shoulders, the subscapularis stretched and the volume of SSB was decreased. Then, SSB fluid leaked out to the GHJ through the Weitbrecht hole, and secondary the fluid in GHJ leaked out to the SAB through the rotator cuff tear site. The morphology and kinematics of capsule and bursae in rotator cuff tear were evaluated by 3DCT images. The subscapularis kinematics was related to the change of SSB volume.
  • 大内 洋, 後藤 達広, 内田 繕博
    2010 年 34 巻 3 号 p. 625-628
    発行日: 2010年
    公開日: 2010/11/16
    ジャーナル 認証あり
    Various previous studies have focused on ultrasound guided suprascapular nerve block techniques. However, only a few have explained the technique of visualizing the suprascapular notch (SSN), and none have explained a reproducible method to view the entire notch. The purpose of this study is to report a reproducible technique to view the entire SSN and superior transverse scapular ligament (STSL) using an ultrasound scanner. We performed three viewing techniques using the Hitachi EUB-7500 ultrasound scanner platform with the EUP-C532 mini-convex transducer (frequency variable from 8.0-4.0 MHz). The first technique was holding the transducer parallel to the scapular plane and shifting it laterally. The second technique was to hold the transducer parallel to the scapular spine and perpendicular to the scapular plane. The third technique was to hold the transducer perpendicular to the scapular plane at its superior edge, then rotating the probe so as to point towards the base of the coracoid process. Author H.O. performed the scan, and author T.G. evaluated the pictures for SSN and STSL visibility. All methods were successful in visualizing the SSN and STSL. Our first technique had the problem of an acoustic shadow from the clavicle covering the lateral border of the SSN. Our second technique had the problem of not being able to show the shape and depth of the SSN, although its location was apparent. Our third technique was most successful in visualizing the entire SSN as well as the STSL. Holding a mini-convex transducer perpendicular to the scapular plane at its superior edge, then rotating the transducer to point towards the base of the coracoid process was a reproducible and practical method of visualizing the SSN and STSL.
  • 山中 芳
    2010 年 34 巻 3 号 p. 629-632
    発行日: 2010年
    公開日: 2010/11/16
    ジャーナル 認証あり
    The aim of this study was to evaluate the usefulness of the 3 dimensional ultrasonography (3DUS) of the supraspinatus (SSp) tendon based on the T2 weighed MRI(STIR) findings of the same tendon. Both 3 DUS and MRI were performed on the SSp tendons of 65 patients. The right shoulders were involved in 46 patients, left in 27 patients and both in 8 patients. 3DUSs of SSp tendon were divided into 4 groups by their configurations namely convex type, flat type, irregular type and defect type.
    T2 weighed MRIs (STIR) were classified into 4 types by the location and extent of high signal intensity(HSI), namely none(N) : no HSI was present in the tendon, ( B ) : HSI was located in bursal side of the tendon, ( I ) : HSI was located in the middle of the tendon, ( J ) : HSI was located in the joint side of the tendon and ( C ) : HSI was located in the whole depth and some width of the tendons.
    I analyzed 3DUSs by the distribution of HSI of MRIs. Convex type revealed HSI (B, I, J, and C) in 44.7%(17/38), flat in 87.5% (7/8), irregular in 89.5% (17/19) and defect in 100% (8/8). As the HSI of ( C ), convex type revealed in 10.5% (4/38) , flat in 50% (4/8 ), irregular in 36.8% (7/19) and defect in 87.5% (7/8). The HSI of T2 weighed MRI demonstrate the torn portion of SSp tendons. Therefore, this classification of 3DUS and 3DUS of the SSp tendon seemed to be useful for detecting the pathology of the SSp tendon.
  • 松浦 恒明, 進 訓央, 大江 健次郎, 朝倉 透
    2010 年 34 巻 3 号 p. 633-636
    発行日: 2010年
    公開日: 2010/11/16
    ジャーナル 認証あり
    We evaluated the operative findings of the partial rotator cuff tears on MRI using our classification. We examined 61 cases (average age 62.2 years old) with partial rotator cuff tears who were performed preoperative MRI and ARCR from June 2003 to May 2009. We classified the shapes of the torn cuff end into four groups (signal abnormal type, signal abnormal and swelling type, cut off end type, tapered end type) on MRI and compared this with the operative findings which were classified capsular side tear, bursal side tear and both side tears. Signal abnormal type and signal abnormal and swelling type were inclined to conform to the partial capsular side tears. Cut off end type and tapered end type were inclined to conform to the partial busal side tears.
  • 岩堀 裕介, 加藤 真, 梶田 幸宏, 佐藤 啓二, 花村 浩克, 筒井 求
    2010 年 34 巻 3 号 p. 637-640
    発行日: 2010年
    公開日: 2010/11/16
    ジャーナル 認証あり
    The purpose of this study is to investigate the pathological significance of peel back phenomenon (PBP) of the superior labrum of the shoulder by arhthroscopic dynamic examination. We studied 55 shoulders of 55 patients who underwent arthroscopic surgery. There were 39 male and 16 female patients. The average age at operation was 28.7 years old (range 14-65). Shoulder instability and posterior tightness were evaluated under general anesthesia. The type of SLAP lesion, and the grade of PBP with shoulder abduction and external rotation simulating late cocking position was evaluated arthroscopically. There were 39 shoulders with positive SLAP lesion (type I:22, II:13, III:3, IV:1) and 16 shoulders with negative SLAP lesions. There were 25 shoulders with positive PBP and 30 shoulders with negative PBP. No significant differences in PBP positive rate were observed with or without SLAP lesion, displaceability of the superior labrum, anterior instability, and posterior tightness. There were no relationships observed between PBP and SLAP lesion, anterior instability, and posterior tightness of the shoulder. Peel back phenomenon of the superior labrum of the shoulder was supposed to be dynamic variant.
  • 石谷 栄一
    2010 年 34 巻 3 号 p. 641-643
    発行日: 2010年
    公開日: 2010/11/16
    ジャーナル 認証あり
    We reported the differences of scapula-spine distance (SSD) between the affected and un-affected side were increased in the large size of RCT. The purpose of this study is to measure the SSD before and after operation and to investigate whether to improve the displacement of scapula. We examined 84 cases that had ARCR and had postoperative follow of six months. We measured SSD of both sides at the upper distances between the medial border of the spine of the scapula and the spinous process of the same height and at the lower distances between the inferior angle of scapula and that. We measured the tear size by arthroscopy. The small group (under 1cm) had 12cases. The medium group (1-3cm) had 40cases. The large group (over 3cm) had 32cases. The evaluation of MRI at six months postoperative used Sugaya classification. The re-tear group belonging to Type IV and V had 7cases (8.3%). The difference of SSD before and after operation. Small group: the upper +2.1mm, +0.5mm and the lower +3.2mm, +1.9mm. Medium group: the upper +4.2mm, +1.3mm and the lower +3.0mm, +1.2mm. Large group: the upper +7.5mm, +1.7mm and the lower +9.4mm, +3.2mm. Re-tear group: the upper +10.7mm, +3.4mm and the lower +8.9mm, +7.1mm. The differences of SSD at six months postoperative in all groups were decreased in comparison with pre-operation. However in the re-tear group it did not show enough to improve. When the function of the rotator cuff muscles were recovered, the anterior displacement of humeral head got better and the scapula returned to the normal position. It was thought that the improvement of the differences of SSD reflected the effect of ARCR.
  • 進 訓央, 松浦 恒明, 大江 健次郎, 朝倉 透
    2010 年 34 巻 3 号 p. 645-649
    発行日: 2010年
    公開日: 2010/11/16
    ジャーナル 認証あり
    We report 3D (3Dimension) reconstruction of shoulder joint images using INTAGE Realia (free image processing software). Here is how to use INTAGE Realia.1) download and install INTAGE Realia(KGT inc.) from the internet to your own personal computer. 2) export the dicom (digital image communication in medicine) voxel data to your own personal computer. 3) analyze the data using INTAGE Realia, and then automatically complete 3D reconstruction within ten seconds.
    INTAGE Realia can reconstruct large data speedily, and show oblique free cutting images. Also INTAGE Realia has virtual endoscopy mode, and can show the inside of the shoulder joint using contrast - enhanced MRI data. These images help us to deepen our 3dimensional and cross - sectional understanding, and explain them to young doctors and patients.
    [conclusion] We concluded that 3D reconstruction of shoulder joint image using INTAGE Realia on your own personal computer is very useful.
先天性疾患
  • 池上 博泰, 小川 清久, 中道 憲明, 松村 昇, 高山 真一郎
    2010 年 34 巻 3 号 p. 651-654
    発行日: 2010年
    公開日: 2010/11/16
    ジャーナル 認証あり
    Sprengel's deformity is not just the malposition of the scapula, but it is also often associated with dysplasia of muscles around the scapula. We studied the influence of this dysplasia on the treatment of modified Woodward's method. We observed twelve patients ( 3 males, 9 females) of whom we could evaluate the muscles around the scapula by 3DCT and MRI before surgery. The operation method was modified Woodward's method in which we lowered the scapula after osteotomy of the clavicula. In the case with dysplasia of muscles, the scapula moved to a higher position at the final observation compared to the position soon after the surgery. The abduction improved from 96 degrees(on average)before the surgery to 146 degrees. As for complications, two keloid scars and one temporary cranial nerve palsy were found. Woodward's method observed improvement of functions and less complications. However, in the case with dysplasia, as there was limited improvement aesthetically and there were also some relapses, long-term follow-ups are necessary.
  • 瀬川 裕子, 西須 孝, 落合 信靖, 見目 智紀, 佐野 栄, 森石 丈二, 三笠 元彦
    2010 年 34 巻 3 号 p. 655-658
    発行日: 2010年
    公開日: 2010/11/16
    ジャーナル 認証あり
    Although functional results of Wilkinson's scapular osteotomy for Sprengel's shoulder were reported satisfactory without any neurological complications, we have experienced some cases of post-operative glenohumeral instability with downward rotation of the scapula. Here, we retrospectively investigated whether Wilkinson's osteotomy accelerated downward rotation of the scapulas. Eleven shoulders of 10 patients were reviewed for this study. Mean age at surgery was 6.2 ± 2.6 years old and mean follow-up term was 7.2 ± 5.9 years. The rotation angle of the scapula, range of shoulder motion and Cavendish grade were investigated. Rotation angle was defined as 0 degrees when glenoid was perpendicular to the horizontal line and upward rotation was defined as positive in direction. Mean rotation angle were -7.4 ± 6.5 degrees at the final follow-up, and -7.5 ± 8.0 degrees before operation. There was no significant difference. Shoulder motion and Cavendish grade were significantly improved. Among the 10 cases whose scapulas rotated downward, 2 patients (20.0%) showed symptomatic shoulder instability. Twelve years after the operation, multidirectional instability with limited range of motion due to pain was observed in a sixteen-year-old boy. Positional posterior subluxation and multidirectional instability were found in a five-year-old boy two years after the osteotomy. His symptom was improved at the final follow-up. We could not clarify whether Wilkinson's osteotomy accelerated downward rotation of the scapulas. We thought that a recent report of Mears' scapular osteotomy might resolve this problem.
  • 山田 勝久, 船越 忠直, 三浪 明男, 末永 直樹, 大泉 尚美, 榎本 光宏, 大関 覚
    2010 年 34 巻 3 号 p. 659-662
    発行日: 2010年
    公開日: 2010/11/16
    ジャーナル 認証あり
    Previous reports indicated malrotation of the scapula toward inferior would be associated with Sprengel's deformity. We have reported short term results of a novel method, a partial scapular resection, a removal of the omovertebral bone and a partial trapezius muscle transfer for improvement of scapula abduction. The purpose was to evaluate the mid-long term clinical results of the new surgical procedure for Sprengel's deformity.
    The novel surgical procedure had been performed for three Sprengel's deformities, 1 male and 2 female patients (age range. 3 to 4 years old). The mean follow-up period was 83 months. They were evaluated by range of motion, Cavendish classification, x-ray, and CT scan.
    The range of flexion/abduction improved postoperatively from 97/103 to 167/170. The cosmetic appearance improved by a mean of 2 levels on the Cavendish scale. The final average scapular lowering was 1 vertebral height compared with the initial radiographic examination. The angles of the glenoid toward spinal line improved from 72.5 to 49.5 degrees.
    The range of motion, the cosmetics of the shoulder and the original malrotation of the scapula was improved and maintained by this surgical procedure in the mid-long term.
  • 見目 智紀, 落合 信靖, 西須 孝, 瀬川 裕子, 森石 丈二, 三笠 元彦
    2010 年 34 巻 3 号 p. 663-666
    発行日: 2010年
    公開日: 2010/11/16
    ジャーナル 認証あり
    We examined the shoulder function in patients with congenital clavicle and congenital muscle defect around the shoulder. 26 shoulders of 19 patients with congenital clavicle and congenital muscle defect around the shoulder were retrospectively investigated for this study. Diagnoses were congenital pseudoarthrosis in 3 patients, major defect due to cleidocranial dysplasia in 3 patients, congenital midshaft defect of clavicle in 1 patient, distal defect related to congenital progeroid syndrome in 1 patient, proximal half defect related to Goltz syndrome in 1 patient, congenital sternum defect in 1 patient, total absence of the trapezius in 2 patients, partial absence of trapezius in 1 patient, and Poland syndrome in 7 patients. The mean follow-up term was 5.4 years. We evaluated their range of motion (ROM) of shoulder and activities of daily living. In the case of congenital midshaft defect of clavicle and 2 pediatric cases of cleidocranial dysplasia, slight limitation of anterior elevation of shoulder was admire. This limitation has been improved with growth. In the remaining cases, there was no limitation. All patients' daily activities were not disturbed. In the 2 cases of absence of trapezius, ROM limitation, especially lateral elevation, has appeared with growth. But there were no limitation in patients with Poland syndrome. In congenital defect, the dysfunction due to the bone defect was able to be compensated for with muscles. But the dysfunction due to the muscle defect was not be able to compensated with muscles and the limitation showed the tendency to deteriorate for the weight of the arm.
脱臼
  • 中川 滋人, 水野 直子
    2010 年 34 巻 3 号 p. 667-669
    発行日: 2010年
    公開日: 2010/11/16
    ジャーナル 認証あり
    The purpose was to investigate the clinical features of traumatic anterior shoulder instability in baseball and softball players. Patients who suffered traumatic anterior shoulder instability totalled 170, and there were 72 contact sports players, 41 overhead sports players, and 57 others. Among them, 100 shoulders underwent operation. The most popular sport was baseball 21 cases. Their mean age, including 2 softball players, was 19.7 years old, and there were 4 pitchers, 2 catchers, 17 field players. The throwing side was affected in 12 cases, and the non-throwing side was affected in 11 cases, and there was first time instability in 9 cases and recurrent instability in 14 cases. They were injured by head sliding in 7 cases, by diving catching in 4 cases, and at back to base in 4 cases. Among them, 12 innitially suffered subluxation, which were injured by hyperflexion of the shoulder. Regarding their disability in 14 players with recurrent instability, while 3 of 6 throwing shoulders complained of throwing pain and the other 3 shoulders complained of dislocation at throwing, 5 of 8 non-throwing shoulders complained of apprehensive sensation and/or pain at back to base or at catching. Among ten players who underwent operation, all of them suffered recurrent instability, and all of 8 players suffering on the non-throwing side underwent operation. Among nine operated players who were followed up for 1 year minimally, 8 players could completely return to pre-injured level, one throwing shoulder could not. In conclusion, it is important to take care of the subluxation of the non-throwing shoulder at base running and fielding in baseball players.
  • 多田 博, 戸嶋 潤
    2010 年 34 巻 3 号 p. 671-674
    発行日: 2010年
    公開日: 2010/11/16
    ジャーナル 認証あり
    Since 2005, the authors used modified Henry's procedure as a surgical treatment for acute complete acromioclavicular dislocation. Surgery was indicated for Rockwood type III, IV or V injury in young athletes or heavy labors. Under general anesthesia, the acromioclavicular joint was exposed and the ruptured disc was excised. Two holes were made on the undersurface of the lateral clavicle and one hole was made on the top of the coracoid process. A strip of fascia lata two centimeters in width and eight centimeters in length was collected. After over-reduction of the acromioclavicular joint and Kirschner wires fixation, the folded strip of fascia was grafted for the coracoclavicular ligament. The graft fixation on the clavicle was performed in a pull-out manner and on the coracoid a bone anchor was used. Five patients were reviewed more than six months after surgery. They were all men and the age at the surgery ranged from 15 to 40 (average, 21) years. Although one patient experienced slight pain, other patients had no pain. There was none who had limitation of the shoulder motion, weakness or limitation in the daily living. Radiologically, one case was evaluated as residual subluxation and the others were evaluated as good reduction. Although this report is preliminary, the modified Henry's procedure is supposed to be the most effective option for the treatment of the acromioclavicular dislocation.
  • 田久保 興徳, 森原 徹, 仲川 春彦, 堀井 基行, 久保 俊一, 黒川 正夫
    2010 年 34 巻 3 号 p. 675-678
    発行日: 2010年
    公開日: 2010/11/16
    ジャーナル 認証あり
    The treatment of recurrent shoulder dislocation with global rotator cuff tear is a controversial problem. We report the clinical results of the modified Bristow procedure for recurrent shoulder dislocation with global rotator cuff tear. We examined 6 shoulders of 6 patient s(1 male and 5 females, 65 ∼ 81 years old, average; 74 years old)who underwent modified Bristow procedures for recurrent shoulder dislocation with global rotator cuff tear. Over one year after operation, clinical results were evaluated. T he “visual analogue scale(VAS)” pain scale was used. Bone healing of the transferred coracoid process seen with X-ray or CT scan, instability, range of motion, and JOA score were investigated. The mean follow-up period was 29 months. The VAS was 12/100. All shoulders had good bone healing. There was no recurrent dislocation but there was one subluxation. The mean range of motion, flexion, abduction, external rotation, and internal rotation were 130°, 137°, 33°, Th9.7, respectively. The average JOA score was 83.3 points. It is difficult to acquire good results from cuff repair in the cases of recurrent shoulder dislocation with global rotator cuff tear, because of the long period of rehabilitation and high risk of re-tear. Good results were obtained from the modified Bristow procedure in these cases due to early training of range of motion.
  • 水野 直子, 中川 滋人, 米田 稔, 林田 賢治
    2010 年 34 巻 3 号 p. 679-682
    発行日: 2010年
    公開日: 2010/11/16
    ジャーナル 認証あり
    Most of the studies on recurrent anterior shoulder dislocation in older patients have shown pathologies related to rotator cuff tears. However, the pathologies focusing on the anterior capsular mechanism of older patients without rotator cuff tears have not been well elucidated. The purpose of this study was to assess the pathological features of the anterior capsular mechanism in older patients with recurrent anterior shoulder dislocation in the absence of rotator cuff tears. Between 2002 and 2007, 38 patients (40 shoulders, 12 males and 26 females) aged more than 40 years underwent arthroscopic treatments for recurrent anterior shoulder dislocation. There were no patients with rotator cuff tears. The average age at the operation was 52 (40-72)years old. The average age at the time of initial dislocation was 30.8 (9-70) years old. Patients were divided into 2 groups by age of the initial dislocation. Group A (<40 y.o.) was 31 shoulders, Group B (>40 y.o.) was 9 shoulders. We performed arthroscopic evaluation of anterior capsular mechanism on all the patients. Bankart lesion was seen in 32 shoulders (Group A: 87.1%, Group B: 55.6%). Midsubstance complete tear of IGHL (IGHL tear) was seen in 14 shoulders (A: 29%, B:55.6%). HAGL lesion was seen in 3 shoulders (A: 6.5%, B: 11.1%). According to all the pathologies, isolated Bankart lesion was seen in 21 shoulders (A: 65.4%, B: 33.3%). Bankart lesion with IGHL tear was seen in 9 shoulders (A: 22.6%, B: 22.2%). Isolated IGHL was seen in 5 shoulders (A: 6.5%, B: 33.3%). In comparison with younger patients and older patients, the prevalence of the isolated Bankart lesion was low, but the prevalence of the IGHL tear was high in older patients. We should keep in mind the existence of the IGHL tear in older patients and evaluate the whole anterior capsular mechanism meticulously.
  • 岩噌 弘志, 榊原 精一郎
    2010 年 34 巻 3 号 p. 683-686
    発行日: 2010年
    公開日: 2010/11/16
    ジャーナル 認証あり
    Introduction: Recently, it has become possible to repair the bony Bankart region by an arthroscopic procedure.We report a new fixation technique (DAFF) for the bony Bankart region.
    Material: The subjects were 14 males. In all cases, injury to the bony Bankart region was confirmed by CT examination. The average age at operation was 29 years old.The average follow-up period was 12 months. 1) The reduced position of the bony Bankart fragment was maintained by a modified TOTS method. 2) Medial anchor: A knotless anchor with 2 loops penetrated through the bony Bankart fragment at the scapular neck on the medial side. 3) Lateral anchor: The two loops were individually fixed to the edges of the scapular joint surface to form a V-shape using the knotless anchor. 4) If necessary, procedures 2) and 3) were repeated. 5) AW-shape was created by performing these procedures twice.
    Results: All case achieved bone union as confirmed by CT.The mean pre- and post-operative JSS scores were 45 and 88, respectively, showing improvement. The average preoperative Rowe score was 20, while the average postoperative score was 82.
    Discussion: The advantages of this procedure (DAFF) are as follows: (1) Anatomical repair of the Bankart region is possible. (2) Handling is easy because of the knotless anchor and method. (3) Special arthroscopic devices are not required. (4) Even when the bony fragment is large, it remains easy to insert the medial anchor. Conclusion Dual row fixation for bony Bankart lesion achieved good short-term results.
  • 道家 孝幸, 上野 栄和, 水野 諭, 岡村 健司, 廣瀬 聰明, 野中 伸介, 木村 重治
    2010 年 34 巻 3 号 p. 687-689
    発行日: 2010年
    公開日: 2010/11/16
    ジャーナル 認証あり
    The purpose of this study was to evaluate clinical results of arthroscopic Bankart repair for contact sports athletes with recurrent anterior shoulder instability. We retrospectively studied 19 patients (21 shoulders) who were treated with arthroscopic Bankart repair and were followed-up for more than 1 year postoperatively. The average age at the time of surgery was 19.8years old (range, 16 to 34), the average follow-up was 38.5 months (range, 12 to 69). Indication of arthroscopic Bankart repair was that we could repair AIGHL-Labrum complex and glenoid bone loss was 25% or less. We evaluated the clinical outcome by JSS shoulder instability score, level of return to sports activities, the recurrence rate of dislocation, satisfaction level and complications. The average postoperative JSS score was 79.8. Although all patients returned to contact sports, 39% could not return to preinjury sports activity levels. 3 patients had recurrence of dislocation, and 7 reported fear of recurrence when tackling. Satisfaction was 14 satisfied, 3 slightly satisfied, 4 slightly unsatisfied. There was one patient with ER limitation, postoperatively. Previously, we had treated contact sports athletes with recurrent anterior shoulder dislocation with the modified Bankart and Bristow procedure. Although the recurrence rate was low, the range of motion was limited in almost half the patients. Although in this study was all patients returned to contact sports activities, the recurrence rate was 14.3% and incomplete return was 39%. We think arthroscopic Bankart repair is not satisfactory for contact sports athletes.
  • 大見 博子, 内山 善康, 繁田 明義, 橋本 紘行, 持田 讓治, 新福 栄治
    2010 年 34 巻 3 号 p. 691-695
    発行日: 2010年
    公開日: 2010/11/16
    ジャーナル 認証あり
    The purpose of this study was to evaluate the clinical results after arthroscopic Bankart repair (suture anchor technique) for traumatic anterior instability of the shoulder. We evaluated 23 shoulders (20 males and 3 females) treated with arthroscopic Bankart procedure. The average age at operation was 24.0 (15-36) years old. The average follow-up period was 34.2 (12-68) months. Clinical evaluation included rate of recurrent instability and range of motion (external rotation at anatomical and 90° abduction). All patients were assessed by the scoring systems of JSS-SIS (Japan Shoulder Society Shoulder Instability Score) and Rowe score in preoperative examination and at the final evaluation. In addition, 3D-CT imaging was performed for evaluating bone morphology (anterior bone defect). Statistical analysis of data was performed using Mann-Whitney U test. There was 1 repetitive redisloaction and 3 one time resubluxation (total 17.4%). There were 6 cases (26.1%) of bony Bankart lesions, and 17 cases (73.9%) of erosion or compression of the anterior glenoid. Recurrent cases had major trauma associated with the activity of contact and collision sports and/or bone defect of the anterior glenoid over 30% by 3D-CT. Postoperative mild limitations of external rotation at anatomical a nd 90° abduction were 5.7 ± 5.8° and 9.2 ± 6.3°, respectively. The average JSS-SIS was improved significantly from 59.1 ± 6.2 points preoperatively to 93.6 ± 9.6 points postoperatively, the average Rowe score was improved significantly from 36.5 ± 9.4 points preoperatively and 87.1 ± 20.9 points postoperatively. The recurrent rate was 17.4% after arthroscopic Bankart repair in our cases. These recurrence cases related to risk factor of recurrent instability after arthroscopic operation, for example, major trauma associated with an activity of contact and collision sports and/or bone defect of anterior glenoid over 30%. This study suggested that high-risk patients needed to add augmentation to the original technique.
  • 中村 篤司, 神戸 克明, 安井 謙二
    2010 年 34 巻 3 号 p. 697-700
    発行日: 2010年
    公開日: 2010/11/16
    ジャーナル 認証あり
    Arthroscopic Bankart repair is commonly used for treatment of recurrent shoulder dislocation. However it is difficult to detect before surgery what factors affect the outcome of arthroscopic Bankart repair. The aim of this study is to investigate the clinical factors which are related to the outcome of arthroscopic Bankart repair in our institute. We tried to assess the outcome of arthroscopic Bankart repair in our institute in 27 shoulders in 25 patients (17 males and 8 females) with an average age of 37.3 years old and an average follow-up period of 2.4 years by using multiple regression analysis in JSS score before and after surgery. JSS scores changed from an average of 54 before surgery to an average of 91 after surgery. Rowe score was changed from an average of 40 before surgery to an average of 91 after surgery. We performed arthroscopic Bankart repair by 2 portals in 14 shoulders that had excellent result as well. One out of 27 shoulders showed redislocation of a skier (redislocation rate was 3.7%). There was a significant relationship between JSS score before surgery and XP finding after surgery (r=0.738), XP finding and instability before surgery (r=0.474), JSS score before surgery and function after surgery (r=0.421) respectively. Range of motion (P=0.003), function (P=0.018) and pain (P=0.043) related to JSS score after surgery. JSS score before surgery related to function (P=0.004) and XP finding (P=0.001) after surgery. Therefore ROM before surgery is an important factor to predict the outcome of arthroscopic Bankart repair.
  • 高瀬 勝己, 佐藤 由佳, 新村 光太郎, 山本 謙吾
    2010 年 34 巻 3 号 p. 701-704
    発行日: 2010年
    公開日: 2010/11/16
    ジャーナル 認証あり
    We have performed arthroscopic Bankart procedure using an absorbable or metallic suture anchor for traumatic anterior shoulder instability. In this study, we report the frequency, pathology and therapeutic results of patients treated for SLAP lesion concomitant with Bankart lesion. The subjects were 20 patients (Group A). The mean age at the time of surgery was 33.8 years old. On arthroscopic findings, SLAP lesions were classified into type 2 in 15 cases and type 4 in 5 cases based on Snyder's criteria. Also, SLAP lesion with intra-articular free bodies was presented in 2 cases, and SLAP lesion with capsular tear in 1. We performed the only debridment (Group A1) or re-attachment (Group A2) to the superior glenoid edge of these lesions, considering whether these lesions communicated to Bankart lesion or not. The therapeutic results were evaluated according to the JOA score and JSS shoulder instability score. The mean JOA and JSS Shoulder Instability score was 95.1 and 90.8. No pain remained and there was no recurrence of instability in any cases of Group A. Meanwhile, on detailed analysis in JSS Shoulder Instability score between Group A1 and A2, the mean score of function and the range of motion were 18.9 points and 15.1 points in Group A1, and 17.5 and 10.1 in Group A2, respectively. There was a significant correlation in the range of motion between Group A1 and A2 (P=0.04). Regarding the postoperative limitation in external rotation with the arm at side, the difference in the range from that on the healthy side was 9.8 degrees in Group A (7.0 in Group A1 and 12.6 in Group A2). When SLAP lesion communicated to Bankart lesion, we could have satisfactory results for these patients without repair for SLAP lesions. Therefore, we think that we should avoid the unnecessary repair or address for the concomitant pathology, or that we should perform the different postoperative care for these patients with Bankart repair with re-attachment of SLAP lesion.
  • 松村 昇, 池上 博泰, 吉田 篤, 小川 清久
    2010 年 34 巻 3 号 p. 705-708
    発行日: 2010年
    公開日: 2010/11/16
    ジャーナル 認証あり
    The purpose of this study was to evaluate the clinical results of Bankart-Latarjet procedure for anterior shoulder instability with significant glenoid defect. During the period between 2000 and 2006, high demand patients underwent Bankart-Latarjet procedure for traumatic anterior shoulder instability with greater than 25% glenoid bone loss and we could follow up on 12 cases for more than 2 years after the surgeries. In operation, we first performed transosseous Bankart repair, and transferred the coracoid process, laid flat on the glenoid neck with 2 cancellous screws. We assessed postoperative complications, active shoulder range of motion, and clinical results evaluated by JSS instability score and Rowe score. With a mean follow-up time of 6.0 years, none of these patients showed any recurrent instability. The transferred coracoid process had united in all cases and there was no evidence of fracture nor absorption. Two cases showed osteoarthritic advancement of the glenohumeral joint. Active elevation and external rotation significantly increased after the surgeries (p < 0.05). Compared with the contralateral side, however, external rotation was limited by 10.6° with the arm at the side and 5.6° with the arm abducted at 90°. The mean JSS instability score had been 50.6 preoperatively and improved to 92.0 at the time of final follow-up (p < 0.05). Rowe score had also significantly improved from 39.2 to 91.3 (p < 0.05). Satisfactory outcomes were achieved by Bankart-Latarjet procedure for traumatic anterior shoulder instability with glenoid defect. Postoperative limited range of external rotation might be caused by relative shortening of the anterior capsule following glenoid defect. To assess the postoperative osteoarthritic change, we should follow the cases long term.
  • 村田 亮, 黒田 重史, 石毛 徳之, 三笠 元彦
    2010 年 34 巻 3 号 p. 709-712
    発行日: 2010年
    公開日: 2010/11/16
    ジャーナル 認証あり
    The glenoid of the scapula is an essential component of glenohumeral joint and is known to act as a static stabilizer. Meanwhile, the function of the glenoid may be interpreted as a dynamic stabilizer since it upwardly rotates to keep the scapulo-humeral rhythm during shoulder elevation. The purpose of the current study was to analyze the functional aspect of the glenoid comparing the clinical subjects with stable and unstable shoulder. Patients with habitual shoulder dislocation (unstable group: n=11) and with the shoulder lesion without anterior instability such as rotator cuff tendinitis, SLAP lesion and shoulder contusion (control group: n=52) were involved. Two radiographs were taken of each subject (anteroposterior in internal rotation: IR1, zero position). Two straight lines were drawn from superior and inferior tubercle to the center of the humeral head in IR1 image, and the angle of the line was measured (α angle). The difference of the glenoid inclination angles between IR1 and Zero position (β angle) are then measured, and the glenoid extension ratio (α+β/α) was calculated and statistically analyzed with paired T-test. No significant difference was found in α angle between the two groups. The glenoid extension ratio and β angle was significantly lower in the unstable group than in the control group (p< 0.01). The extension ratio may be regarded as an index of "functional glenoid" in shoulder elevation. This result showed that the augmentation of the "functional glenoid" should be emphasized in the treatment of unstable shoulder, as represented by habitual shoulder dislocation. The appropriate physical therapy may be primarily indicated following this concept.
  • 松本 一伸, 伊藤 陽一, 間中 智哉, 大戎 直人, 中村 信之, 中村 博亮
    2010 年 34 巻 3 号 p. 713-716
    発行日: 2010年
    公開日: 2010/11/16
    ジャーナル 認証あり
    Arthroscopic capsular plication has been reported to be a novel surgical treatment for MDI: Multidirectional instability of the shoulder, which was previously treated by capsular shift open surgical procedure. The purpose of this study was to evaluate short term clinical results of arthroscopic capsular placation for MDI. We retrospectively evaluated 17 shoulders (16 patients, 15 male and 1 female) arthroscopically treated by capsular plication. Arthroscopic capsular plication was performed for the loose capsular portion which was correctly determined by symptom and physical examination under anesthesia.The average age at the time of surgery was 28.17 years old(range, 15-47 years). The average follow-up was 26.0 months (range, 6-60 months). Clinical results were evaluated by symptomatic instability, physical examination and assessment with JSS shoulder instability score. Disappearance of instability by physical examination with no apparent complication was confirmed in all cases and surgical good effect of this procedure was recognized. However we observed symptomatic instability remained in 7 of 17 shoulders (41.2%) and patients' symptom has not yet completely disappeared. The average JSS shoulder instability score improved from 52.4 points preoperatively to 91.4 points postoperatively. Patients treated with Arthroscopic capsular placation for MDI have shown excellent short term clinical outcomes. Longer follow up is necessary for the evaluation of the remaining symptomatic instability.
骨折
  • 横田 淳司, 阿部 宗昭
    2010 年 34 巻 3 号 p. 717-720
    発行日: 2010年
    公開日: 2010/11/16
    ジャーナル 認証あり
    The purpose of this study is to evaluate the short term results of minimally invasive plate osteosynthesis (MIPO) for displaced proximal humeral fractures using a polyaxial locking plate. We examined 7 patients who underwent MIPO for proximal humeral fractures using the non-contact bridging (NCB) plate system with a minimum follow up of 6 months after surgery. These were 2 males and 5 females and the average age was 56.9 years old (37-76 years old). According to AO classification, A2 and A3 was one each, B1 was three and C1 was two. Plate osteosynthesis was done using two small (3cm each) skin incisions. Postoperatively, the arm was immobilized with a sling for 2 weeks and passive motion exercise was initiated the day after surgery. The average operating time was 116 minutes. Bone union was obtained in all patients, but one patient had postoperative displacement of a greater tuberosity fragment which required the revision surgery. The other complications including screw loosening, humeral head perforation of the screws and axilliary nerve palsy were not observed. The average JOA score at 6 months after surgery was 89.6 points (80-94). Although a number of improvements such as the profile of the implant and operative techniques are desired, MIPO with use of a polyaxial locking plate is thought to be a promising procedure for surgical treatment of displaced proximal humeral fractures.
  • 難波 二郎
    2010 年 34 巻 3 号 p. 721-724
    発行日: 2010年
    公開日: 2010/11/16
    ジャーナル 認証あり
    The treatment for proximal humeral fractures (PHF) in older patients has been a challenging problem. The internal locked system (PHILOS) plate is a new device intended to give secure fixation of PHF. We retrospectively review the early functional and radiographic results of the impaction fixation of the humeral shaft into the humeral head in combination with PHILOS plate in a series of selected displaced PHF. The inclusion criteria for the study were 1) AO C type or B type with medial metaphyseal comminution 2) failed treatment including conservative or surgical, and 3) age older than 60 years. Between February 2006 and August 2008, 11 patients were treated surgically with the present method. There were 3 men and 8 women with the average age of 71 years (61-84 years). According to AO classification, there were 2 cases of A2, 2 cases of B1, 1 case of B2, and 6 cases of C2. The clinical assessment was performed by using the shoulder scoring system of the Japanese Orthopaedic Association. Radiographic evaluation was done for nonunion, avascular necrosis, and reduction loss. Follow up averaged 15 months (range; 6months- 3years 4 months). The mean clinical score was 87 % (range 77-97%). Mean Elevation, abduction, and mean external rotation were respectively 116, 111, and 34 degrees. All fractures healed. Screw cutout occurred in two cases, and varus subsidence occurred in two cases. There were no cases of infection, nerve injury, avascular necrosis, nonunion or implant failure. Our study demonstrated that for clinically severe cases of PHF, bone union with satisfactory results can be achieved using an impaction method in combination with PHILOS plate. Although the number reported here is small, the results are encouraging, and we believe that this method is a useful for challenging cases or older patients.
  • 武居 功, 原田 幹生, 村 成幸, 鶴田 大作, 荻野 利彦, 後藤 康夫
    2010 年 34 巻 3 号 p. 725-729
    発行日: 2010年
    公開日: 2010/11/16
    ジャーナル 認証あり
    We performed surgical treatments on 6 (4 males and 2 females) cases of scapula fractures with considerable displacement and instability out of 19 cases of the patients diagnosed in our hospital between Apr. 2007 and May. 2009. The mean age was 46.7 (30-59) years old and the follow-up period was 16.0 (7-26) months. The causes of trauma were falls and traffic accidents. The sites of scapula fractures were glenoid fossa, neck, body, coracoid process, acromion, and their combinations. The associated injuries were clavicle fracture, head or chest injury, anterior fracture-dislocation of the proximal humerus, and massive rotator cuff tear. At the final examinations, 5 cases had no pain and 1 had slight pain on heavy labor. Only 1 case had residual limited range of motion of the shoulder joint, but it did not make difficulties in his activities of daily life and work. All the cases got bone union without residual muscle weakness and returned to their previous work during the follow-up period. Although the indication for surgical treatments on scapula fractures is still controversial, Goss suggestively recommended surgeries for the cases with unacceptable instability and displacement due to double disruptions of superior shoulder suspensory complex, including floating shoulders. Four cases of the present 6 cases met this theory and the other 2 cases had severe associated injuries in addition to displaced scapula fractures, a fracture-dislocation of the proximal humerus and a massive rotator cuff tear, respectively. As we obtained good postoperative results from the present 6 cases, we conclude that a surgical treatment should be considered on scapula fractures with considerable displacement and instability such as a floating shoulder.
  • 原田 幹生, 武居 功, 後藤 康夫, 村 成幸, 荻野 利彦
    2010 年 34 巻 3 号 p. 731-735
    発行日: 2010年
    公開日: 2010/11/16
    ジャーナル 認証あり
    The aim of this study was to investigate the time for bone union, time for return to sports, and complications after treatment for middle-third fractures of the clavicle caused by sports. Twelve patients with middle-third fractures of the clavicle who wished for early return to sports participated in this study. We investigated age at first visit, time for bone union, time for return to sports, and complications. Among six patients without epiphyseal closure of the humeral head, four who underwent conservative treatment were 10-17 years old at first visit. Bone union was achieved in an average of 2.7 months, and return to sports was achieved in an average of 2.3 months. Complications included refracture in one. The remaining two patients without epiphyseal closure who underwent surgery were both aged 14 years at first visit. Bone union was achieved in 1.5 months and 3 months, and return to sports was achieved in 3 weeks and 3 months, respectively. Complications included refracture in one. Six patients with epiphyseal closure who underwent surgery were 21-51 years old at first visit. Bone union was achieved in an average of 4.8 months, and return to sports was achieved in an average of 2.5 months. Complications included screw loosening in one, shoulder contracture in one, and transient nerve disorder in one. Two of the patients without epiphyseal closure (both judoists) may have refracture due to incomplete bone union. In patients with the epiphysial closure, return to sports was achieved before bone union.
筋腱疾患
  • 鶴田 大作, 村 成幸, 荻野 利彦
    2010 年 34 巻 3 号 p. 737-740
    発行日: 2010年
    公開日: 2010/11/16
    ジャーナル 認証あり
    The purpose of this study is to clarify the relationship between clinical, MRI and pathological findings, associated with torn rotator cuff muscles. Materials of this study were Twenty-nine shoulders in twenty-eight patients with rotator cuff tears, treated surgically in our hospital from March (2008) to April (2009). 19 were males, and 10 were females. The mean age at surgery was 63 years. The average periods, onset to the operation, was 18.2 months. The mean size of the tear was 3.3 cm. The mean JOA score was 69.9 points before operation. Needle biopsy was done in all cases at the supraspinatus and infraspinatus muscle, using the 14G needle biopsy kit. The biopsy organization was fixed by fresh freezing and paraffin, and stained using the H-E and Sudan III methods. We evaluated fatty infiltration between muscle fibers and graded 0 to 2, (Grade 0: fat cell (-) at H-E and fat (-) at Sudan III, Grade 1: fat cell (+) at H-E and fat (±) at Sudan III or fat cell (-) at H-E and fat (+) at Sudan III, Grade 3: fat cell (+) at H-E and fat (+) at Sudan III). MRI was enforced one to seven days before the operation in all cases, and we classified the fatty degeneration of rotator cuff muscles, using Nakagaki and Goutallier's Classification. We evaluated and analyzed the relationship between the clinical, MRI and pathological findings statistically. There were fat cells between the muscle fibers, in H-E (paraffin). In the supraspinatus and infraspinatus, there was a relationship between the size of the tear and the fatty degeneration on MRI. In the supraspinatus, there was a relationship between the fatty degeneration on MRI and fatty infiltration between muscle fibers on pathology.
  • 橋口 宏, 岩下 哲, 伊藤 博元
    2010 年 34 巻 3 号 p. 741-744
    発行日: 2010年
    公開日: 2010/11/16
    ジャーナル 認証あり
    The purpose of this study was to analyze prognostic factors relating to recurrent tear of repaired large and massive tears of the rotator cuff. 66 patients with large or massive rotator cuff tears, whose average age was 64.7 years, were the subjects of this study. 29 patients underwent open repair, and 37 patients underwent arthroscopic double-row repair using suture anchors. The average follow-up period was 23.8 months, and postoperative MRI was performed at 13.9 months on average. Postoperative MRI revealed sufficient thickness of the repaired cuff in 42 patients, thinning in 8 and recurrent tear in 16. Factors compared between the 50 patients with no tear and the 16 patients with recurrent tear were as follows; characteristics of the patients, preoperative history of trauma, subscapularis tear, LHB rupture, delamination and size of the tears. All data were evaluated statistically, and the significance level was set at less than 0.05. The patients with recurrent tear were significantly older than those with no tear. The 14 patients without preoperative history of trauma had markedly higher rate of recurrent tear than the 52 patients with history of trauma. The recurrent tear rates of the patients with subscapularis tear, LHB rupture or diabetes were significantly higher than those without them. This study suggests that older age, history of trauma, subscapularis tear, LHB rupture and diabetes may be incriminated as the risk factors of recurrent tear of the repaired cuff. Protective rehabilitation such as long-time immobilization and delay of the start of active motion should be applied to patients with the risk factors to decrease recurrent tear of the repaired cuff. Moreover, secure and tight repair methods or augmentation of the torn cuff should be devised to obtain better structural outcomes.
  • 菊川 和彦, 奥平 信義
    2010 年 34 巻 3 号 p. 745-747
    発行日: 2010年
    公開日: 2010/11/16
    ジャーナル 認証あり
    We assessed the clinical outcome of treatment for the rotator cuff tears with axillary nerve palsy. 13 cases of rotator cuff tears with axillary nerve palsy were treated since 1995. The cases were 9 male and 4 female, with an average age of 62 years. The mean follow up period was 68 months. The duration from trauma to surgery ranged from 5 to 48 weeks. 5 shoulders had massive rotator cuff tears and 8 shoulders had global rotator cuff tears. 11 shoulders were combined with anterior shoulder dislocation, 8 shoulders were treated by arthroscopic repair and 5 shoulders treated by open repair. 4 shoulders were associated with patch graft of tensor fassia lata. All patients were evaluated by the shoulder score of the Japan Orthopedic Association (JOA score). The average postoperative JOA score increased from 34 points to 82 points. The clinical results were excellent in 4 cases, good in 4, fair in 3, poor in 2. The main factor of a JOA score demerit mark was range of motion, and second was pain. There was a correlation between postoperative JOA score and the duration from trauma to surgery. In the treatment of the rotator cuff tears with axillary nerve palsy, the early repair of rotator cuff tear after improvement of axillary nerve palsy is important to gain satisfactory functional results.
  • 榊原 精一郎, 岩噌 弘志
    2010 年 34 巻 3 号 p. 749-751
    発行日: 2010年
    公開日: 2010/11/16
    ジャーナル 認証あり
    Smoking increases the risk of rotator cuff injury. However, few studies have statistically examined this. In this study, we investigated the influence of smoking on rotator cuff injury. Of the 59 patients who underwent surgery for rotator cuff injury in our hospital between 1997 and 2009, 43 were the subjects in this study excluding 10 who sustained high-impact trauma and 6 in whom the presence or absence of smoking was unclear. Ages at the time of surgery ranged from 31 to 76 years, with a mean of 55.0 years. There were 30 males and 13 females. The mean duration of smoking was 22.1 years (range: 10-42 years). One patient had a history of diabetes. Based on data from the Ministry of Health, Labour and Welfare and Ministry of Internal Affairs and Communications, we estimated the number of smokers in Japan. We investigated the influence of smoking on rotator cuff injury by analyzing patients with this injury who were treated in our hospital and Japanese persons with respect to the presence or absence of smoking. We employed the chi square test. P=0.05 was regarded as significant. Of the 43 subjects, 18 had a history of smoking. The proportion of these patients was significantly higher than the smoking rate in Japan (P=.008). These results suggest that smoking is a risk factor for rotator cuff injury.
  • 石垣 範雄, 畑 幸彦, 中村 恒一, 村上 成道, 小林 博一, 伊坪 敏郎, 内山 茂晴, 加藤 博之
    2010 年 34 巻 3 号 p. 753-755
    発行日: 2010年
    公開日: 2010/11/16
    ジャーナル 認証あり
    Postoperative results for the rotator cuff tear are good, but some cases with pain remain. A prior report described about clinical factors of persistent postoperative pain in rotator cuff tears, but we did not refer to the relationship of the postoperative pain and restoration of the rotator cuff in itself. This study determines whether postoperative pain in rotator cuff tear cases influences postoperative results and recovery of the rotator cuff. Among 151 rotator cuff tear patients, aside from those with massive tear, we extracted two groups according to the degree of pain at a one year postoperatively. The Painful group included 30 shoulders causing pain during activities of daily living (UCLA score of Pain < 6 points). The Painless group included 121 shoulders without pain (UCLA score of Pain = 10 points). For clinical evaluation, we examined the preoperative UCLA score and that at 1 year postoperatively. For the configuration evaluation, we estimated the muscle belly thicknesses of SSP, ISP, and deltoid muscles, and the fatty degeneration of SSP muscle on MRI. We compared each item at 6 months and 1 year postoperatively. In the improvement rate of the UCLA score, painless group was significantly higher than painful group. The thickness of ISP and deltoid muscle belly were more significantly improved at 1 year postoperative than at 6 months in the Painless group, but were not significantly improved in the Painful group. The SSP muscle belly was not significantly improved in either group. Fatty degeneration in each group was significantly more improved at 1 year postoperative than at 6 months. In the Painful group, both the improvement rate of postoperative results and the rotator cuff recovery were poor. Results show that pain during postoperative 1 year is inversely related with the index of improvement.
  • 杉森 一仁, 菅谷 啓之, 高橋 憲正, 萩原 嘉廣, 河合 伸昭, 森石 丈二
    2010 年 34 巻 3 号 p. 757-760
    発行日: 2010年
    公開日: 2010/11/16
    ジャーナル 認証あり
    Although infraspinatus (ISP) is a muscle that may be associated with loss of muscle strength in rotator cuff (RC) tear patients, teres minor (TM) should also play a role in the postoperative disturbance of external rotaion. However, few reports have evaluated the role of TM in patients with RC tear. The purpose of this study was to measure the volume of TM using MRI to obtain baseline data that we can use to evaluate the influence of TM in the postoperative results of RC tear. Seventy-four shoulders (45 males and 29 females) with small RC tears were studied. We have measured cross-sectional area (CSA) of RC muscle using the oblique sagital image of MRI. Fatty infiltration of the muscle was evaluated according to the classification of Goutallier. The CSAs of males were larger than those of females. To revise the CSAs under gender gap, we divided the CSAs by each patient's height or weight. However, we could not revise gender gap in this method. Next, we divided the CSA of TM by that of another RC muscle. We can revise this gender gap clearly by dividing by subscapularis (SSC). There is only one patient with fatty infiltration in TM and 5 in SSC, whereas 45 in supraspinatus (SSP) and 31 in ISP. Then we divided the CSA of TM into two groups, with or without fatty infiltration in another RC muscle. We recognized unevenness in the data of the TM/ISP and TM/SSC with infiltration. We have shown that we can revise the CSA of TM by dividing of another RC without fatty infiltration. The CSA of TM by revision of another RC muscle without atrophy was 61.1 and 52.6% of that of SSP, 41.3 and 38.4% of ISP, and 21.5 and 21.3% of SSC, male and female respectively.
  • 森原 徹, 小椋 明子, 岩田 圭生, 佐々木 健太朗, 立入 久和, 仲川 春彦, 田久保 興徳, 久保 俊一, 平田 正純, 黒川 正夫 ...
    2010 年 34 巻 3 号 p. 761-765
    発行日: 2010年
    公開日: 2010/11/16
    ジャーナル 認証あり
    The treatment for massive rotator cuff tear is difficult. We investigated the pre-, intra, and postoperative evaluation for the torn cuff to improve the clinical results for this disorder. 8 shoulders in 8 patients with large and massive rotator cuff tear were examined in this study. The mean age at the operation was 60.8 years old, and the mean follow-up periods were 14.1months. During operation, the torn cuff was hooked by suture and the tensile strength was measured. After arthroscopic release of supraspinatus and infraspinatus, medial detachment and advancement of the supraspinatus and infraspinatus muscle were performed. The torn cuff was repaired by suture-reel technique within 20N tensile strength. We evaluated the clinical results by JOA score. The repaired cuff integrity was evaluated by MR criteria. The mean tensile strength was over 40N at the edge of torn cuff. The average postoperative JOA score was 86.2 points. Postoperative MR imaging showed type I in 4 cases, type II in 2 cases, type III in 1 case, type V in 1 case. The short term clinical results in this study seemed to be sufficient. To improve the clinical results of large and massive rotator cuff tear, the evaluation of pre-, and intraoperative torn cuff is considered to be important.
  • 松山 嘉彦, 中川 照彦, 多嶋 佳孝, 能瀬 宏行, 二村 昭元
    2010 年 34 巻 3 号 p. 767-769
    発行日: 2010年
    公開日: 2010/11/16
    ジャーナル 認証あり
    The purpose of this study was to report the clinical outcome of arthroscopic treatment for partial-thickness rotator cuff tear. We performed arthroscopic subacromial decompression (ASD) and rotator cuff repair (ARCR) for partial-thickness rotator cuff tear. In this study, a consecutive series of 39 patients with partial-thickness rotator cuff tear, who underwent ASD with ARCR and followed up for more than 6 months, were included. The average age was 61.6 years old (range, 45 to 75 years old), and mean follow-up period was 9.1 months (range, 6 to 24 months). The cases consisted of 20 males and 19 females, 28 right side and 11 left side, 25 BST cases and 14 AST cases. Clinical results were evaluated with the shoulder evaluation sheet of the Japanese Orhopaedic Association (JOA score). 28 of the 39 patients underwent Magnetic Resonance Imaging (MRI) on post operative months from 3 to 6, were classified according to Sugaya's Classification. At the final follow-up, the mean JOA scores was significantly improved from 68.2 (range, 50 to 82) to 89.6 (range, 71 to 100, P<0.01) of BST cases, and from 67.9 (range, 54 to 82) to 90.0 (range, 82 to 98, P<0.01) of AST cases. Postoperative MRI scans were classified into 20 cases type I, 7 cases type II, and 1 case type IV. The mean JOA score of type I was 93.4 (range, 85 to 100), and of type II was 78.7 (range, 71 to 86), and of type IV was 93.0. The group of Type II was worse result than other groups. The clinical outcome of our arthroscopic surgery was good, so combination of ASD and ARCR is one of the important option for treatment of partial-thickness rotator cuff tear.
  • 畑 幸彦, 石垣 範雄, 中村 恒一, 村上 成道, 小林 博一, 伊坪 敏郎, 内山 茂晴, 加藤 博之
    2010 年 34 巻 3 号 p. 771-774
    発行日: 2010年
    公開日: 2010/11/16
    ジャーナル 認証あり
    The purpose of this study was to report the surgical procedure and clinical results of the partial repair that we use for treating cases of rotator cuff tears that are untreatable by primary repair. 30 shoulders, which had more than three tendon tears, were selected from 123 shoulders which had a two-year history after operation for massive tendon tears. They were performed according to the partial repair by Burkhart et al. To evaluate the clinical results, the UCLA score was scored and the range of motion and the muscle strength of the patients were measured. Evaluation by MRI was done by measuring the thickness of the belly of the supraspinatus muscle and the anterior fibers of the deltoid muscle, and fatty degeneration of the supraspinatus muscle belly. The total score of the UCLA score at 2 years after operation improved significantly to 31.9 points (mean value) (p<0.01), with statistically significant improvement of joint motion and muscle strength (p<0.05, p<0.01). Image assessments by MRI revealed no significant improvement in any of the findings defined above. Although the partial repair was insufficient to improve the tendon itself, it did improve the shoulder function: a high level of patient satisfaction was achieved. Therefore, the partial repair might be a good option for the treatment of irreparable rotator cuff tears.
  • 下川 寛一, 伊藤 仁, 松田 智
    2010 年 34 巻 3 号 p. 775-778
    発行日: 2010年
    公開日: 2010/11/16
    ジャーナル 認証あり
    We have been trying to make an arthroscopic reconstruction for irreparable large and massive rotator cuff tears (IRCT) since January 2005. We have reported 14 cases of IRCT (all men, whose average age at surgery was 65.6 years old) who underwent arthroscopic reconstruction. An average preoperative duration of symptoms was 66 months (11 to120 months). The average follow-up period was 25.6 months. The long head of biceps tendon (LHBT) defect was observed in six cases, severe fibrillation or partial tear of LHBT was seen in 8 cases. We thought arthroscopic reconstruction was indicated in patients who have remaining cuff defect after intensive release of the contracted cuff tissues. We performed posterior cuff rotation in 5 cases, hamstrings autograft in 6, fascia lata patch autograft in 2 for posterosuperior defects, and pectoralis major transfer in 3 cases for anterior defects. Outcome analysis included standard clinical follow-up, the Japanese Orthopaedic Association shoulder score (JOA-SS), the QuickDASH score, range-of-motion (ROM), muscle strength, and MRI repair integrity. The JOA-SS, QuickDASH and ROM were significantly improved postoperatively in all cases. Muscle strength in shoulder abduction and external or internal rotation improved after surgery, without statistical significance. Anatomic outcome showed improvement of the cuff defect in all cases. Small to moderate-sized defects were seen in 6 cases, whereas no enlargement of the defect was seen after surgery. The staging of cuff muscle fatty infiltration was unchanged 12 months after surgery. Reconstruction for IRCT is still challenging. Arthroscopic reconstruction will be a potent method for them with improvement of donor selection, combination of tendon transfer and graft, some inventiveness or advance of devices, and skills of surgeons.
  • 石毛 徳之, 黒田 重史, 村田 亮, 丸田 喜美子, 三笠 元彦
    2010 年 34 巻 3 号 p. 779-782
    発行日: 2010年
    公開日: 2010/11/16
    ジャーナル 認証あり
    The purpose of this study is to investigate the clinical results of open tendon transfer for global tear of rotator cuffs. We reviewed 11 shoulders that had rotator cuffs which could not reach at the top of the humeral head. Open acromioplasty and tendon transfer were done. The humeral heads were covered by tendon transfer of infraspinatus and teres minor. After repairing cuffs to bone trough, infraspinatus, teres minor, and supraspinatus tendon were sutured side to side. We sometimes avoided excessive tension of repaired cuffs by additional transfer of subscapularis tendon. The period of postoperative fixation was 6 weeks. The follow up period was 14.7 months. The JOA score (except the evaluation of the X-ray and the stability) was significantly improved from 43.8 preoperatively to 54.7 postoperatively. For 10 shoulders the MRI showed Type II in 3 cases, Type III in 2 cases and Type V in 5 cases by Sugaya classification. It was possible to cover the cartilage of the humeral head by tendon transfer of infraspinatus and teres minor by creating a bone trough more proximal of the foot print. However, 5 in 10 shoulders were considered as re-tear in MRI. This is one method for irreparable rotator cuff tears and it is possible to do it under arthroscopy, but it needs improvement of the suture technique.
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