肩関節
Online ISSN : 1881-6363
Print ISSN : 0910-4461
ISSN-L : 0910-4461
検索
詳細検索
OR
閲覧
検索
34 巻, 3 号
選択された号の論文の93件中51～93を表示しています
すべての抄録を表示する
筋腱疾患
  • 広範囲腱板断裂に対する筋前進術を併用した鏡視下腱板修復術
    平田 正純, 黒川 正夫, 森原 徹, 小椋 明子, 田久保 興徳, 堀井 基行, 久保 俊一
    2010 年 34 巻 3 号 p. 783-785
    発行日: 2010年
    公開日: 2010/11/16
    DOIhttps://doi.org/10.11296/katakansetsu.34.783
    ジャーナル 認証あり
    抄録を表示する抄録を非表示にする
    Arthroscopic surgical procedures for retracted massive rotator cuff tear are debridement, partial repair and patch grafting. We developed a new arthroscopic rotator cuff repair technique combined with arthroscope assisted muscle advancement. The purpose of this prospective study was to evaluate the short clinical results of this procedure. 7 shoulders in 6 patients with massive rotator cuff tear underwent the procedure. The mean age at operation was 67.6 years old and the mean follow-up period was 15.7months. A short skin incision was made on the scapular spine. After endoscopic release of the suprascapular nerve at the suprascapular notch, medial detachment and advancement of the supraspinatus and infraspinatus muscle was performed. The torn cuff was repaired by arthroscopic procedures. We evaluated the clinical results by JOA score. The cuff repair integrity was evaluated by Sugaya's MR criteria. The average final follow-up JOA score was 86.4 points. Postopearative MR imaging showed type II in 3 cases, type III in 1 case, typeV in 3 cases. Arthroscopic rotator cuff repair combined with arthroscope assisted muscle advancement provides satisfactory clinical outcomes. This procedure is considered to be one of the new arthroscopic surgical techniques for massive rotator cuff tear.
    抄録全体を表示
    PDF形式でダウンロード (363K)
  • 肩腱板広範囲断裂に対する鏡視下自家腸脛靭帯移植術の短期治療成績
    森 大祐, 真多 俊博
    2010 年 34 巻 3 号 p. 787-791
    発行日: 2010年
    公開日: 2010/11/16
    DOIhttps://doi.org/10.11296/katakansetsu.34.787
    ジャーナル 認証あり
    抄録を表示する抄録を非表示にする
    The purpose of this study was to describe clinical outcomes, cuff integrity and shoulder muscle strength, of patch grafting using the iliotibial band for irreparable massive rotator cuff tears. We evaluated 10 shoulders in 9 patients (6 males and 3 females, average age: 67.7). The average follow-up period was 16.7 months (range: 12-21 months). One year after operation, the clinical results and cuff integrity were assessed by JOA score and Sugaya's MRI classification, respectively. Preoperative and postoperative degrees of fatty degeneration were determined by Goutallier's classification. Muscle strength was measured with MicroFET at preoperation and one year after surgery. The average JOA score improved from 52.5 to 85.7 points. MRI study declared type 2 repair was seen in 5 shoulders, Type 3 repair in 2 shoulders, Type 5 in 3 shoulders. Re-tear rate was 30 percent. The average JOA score in the re-tear group was 76.5 point. The average shoulder abduction strength improved from 36.1 to 62.3 N at 45 degrees of abduction (P<0.0001), and from 31.0 to 62.3 N at 90 degrees of abduction (P<0.0001). External rotation strength improved from 25.0 to 27.4 N (P<0.05). Internal rotation improved from 76.1 to 85.4 N (P<0.0001). The external rotation strength did not recover well compared with that of abduction and internal rotation. Witout postoperative re-tear, the results of this procedure were favorable. The muscle strength improved significantly, but fatty degeneration did not. We couclude it is necessary to select this procedure, in consideration of the fatty degeneration of the infraspinatus.
    抄録全体を表示
    PDF形式でダウンロード (607K)
  • 広範囲腱板断裂に対する半腱様筋腱 • 薄筋腱移植の成績不良例の検討
    松田 智, 野村 博紀, 岡本 正則, 下川 寛一
    2010 年 34 巻 3 号 p. 793-795
    発行日: 2010年
    公開日: 2010/11/16
    DOIhttps://doi.org/10.11296/katakansetsu.34.793
    ジャーナル 認証あり
    抄録を表示する抄録を非表示にする
    Massive rotator cuff tear is very difficult to care for and postoperative results are not always good. So, we performed semitendinosus tendon and gracilis tendon graft for massive rotator cuff tear (ST • G graft). There are 25% of unsatisfactory cases, who's postoperative MRI is classified as type IV or V according to Sugaya's classification. From 2002 to 2008, we performed ST • G graft on 45 cases, and 40 cases were followed over 6 months and postoperative MRI were taken. We studied the ROM of the shoulder, the shoulder score of Japanese Orthopaedic Society, the size of the rotator cuff tear, the size of the footprint, the rate of right side, rate of male and age. We used t-test and chi-test to compare statistically. There were 8 cases of Sugaya's type I, 16 cases of type II, 6 cases of type III, 3 cases of type IV, and 7 cases of type V. The ratio of the footprint was calculated. We divided the width of the footprint by the width of the head of the humerus, and this ratio is statistically small in unsatisfactory cases. Risk factors of unsatisfactory results of ST • G graft for massive rotator cuff tear were “Male”, “Right side”. “Small ratio of footprint”. Modification of suture technique, operative indication, and tight control of post operative ADL will lead to good results.
    抄録全体を表示
    PDF形式でダウンロード (373K)
  • 腱板断裂手術における合併症　-直視下手術-
    橋本 卓, 信原 克哉
    2010 年 34 巻 3 号 p. 797-801
    発行日: 2010年
    公開日: 2010/11/16
    DOIhttps://doi.org/10.11296/katakansetsu.34.797
    ジャーナル 認証あり
    抄録を表示する抄録を非表示にする
    Complications of surgical treatment of rotator cuff tear are directly related to each surgical procedure. Postoperative failure can be minimized if the surgeon has made accurate diagnosis with identification of the precise anatomical pathology, and knows the rationale for appropriate surgical treatment. Failed rotator cuff repair can be caused by excessive tension of the cuff, incorrect reinsertion in line with the direction of tendon fiber, degenerative change in tendons, and inadequate subacromial decompres-sion. Nonfunctioning deltoid can be caused by incomplete reattaching of the deltoid to the acromion after acromioplasty or axillary nerve injury. Swelling and contracture of the finger was identified after the rotator cuff repair. Infection after rotator cuff repair occurred in seven of 2271 cases over ten years.
    抄録全体を表示
    PDF形式でダウンロード (913K)
  • ラット腱板断裂モデルを用いた腱板断裂後筋組織内脂肪浸潤の分子生物学的解析
    糸魚川 善昭, 佐野 博高, 井樋 栄二
    2010 年 34 巻 3 号 p. 803-806
    発行日: 2010年
    公開日: 2010/11/16
    DOIhttps://doi.org/10.11296/katakansetsu.34.803
    ジャーナル 認証あり
    抄録を表示する抄録を非表示にする
    It has been reported that mechanical stretch increases the gene expression of Wnt10b and decreases adipogenic differentiation of myogenic cells in vitro. We investigated the gene expression of Wnt10b and markers for fatty infiltration in the torn rotator cuff muscle using a rat model. Twenty-four Sprague-Dawley rats were used for the current study. Right supraspinatus and infraspinatus tendons were detached from the greater tuberosity (cuff-tear side). Sham operation was performed in the left shoulders, which served as controls (control side). The rats were euthanized at 3, 7, 14, and 28 days after the surgery. Total RNA was extracted from the proximal and distal parts of the supraspinatus muscles. Then, quantitative PCR reactions were performed to determine the gene expressions of Wnt10b and the adipogenic markers, PPAR γ and C/EBP α. The expression profiles were compared between the cuff-tear and control sides. Fatty infiltration was confirmed by Oil red O staining at 56 days after the surgery. Decreased expression of Wnt10b in the cuff-tear side was observed at 3 and 7 days in the distal part and at 3 days in the proximal part. PPAR γ mRNA expression exhibited significant increase in the cuff-tear side at 28 days. C/EBP α gradually increased in the cuff-tear side. Oil red O positive fatty infiltration was observed at the musculotendinous junction only in the cuff-tear side. Torn rotator cuff muscles showed decreased gene expression of Wnt10b. The reduction of Wnt10b might play a role in the molecular mechanism of the fatty infiltration into the supraspinatus muscle.
    抄録全体を表示
    PDF形式でダウンロード (387K)
  • ポリグルコール酸 (PGA) シートによる一次修復不能な腱板断裂の治療
    望月 由, 永田 義彦, 越智 光夫, 横矢 晋, 大前 博路, 柏木 健児, 菊川 和彦, 奥平 信義, 今田 岳男, 白川 泰山, 安達 ...
    2010 年 34 巻 3 号 p. 807-809
    発行日: 2010年
    公開日: 2010/11/16
    DOIhttps://doi.org/10.11296/katakansetsu.34.807
    ジャーナル 認証あり
    抄録を表示する抄録を非表示にする
    We reported that poly-glycolic acid sheet (PGA) was effective experimentally for the regeneration of the insertion and the proper portion of the rotator cuff tendon. We clinically used the PGA sheet for the repair of the massive rotator cuff injuries. From 2001, we performed rotator cuff repair on 336 cases. Out of 336 cases, patch graft was performed on 62 cases. Thirty two cases had patch graft using the tensor fascia lata performed (PG group) and 30 cases had patch graft using the PGA sheet performed (PGA group). 41 cases were male, 21cases were female. The average age was 58.5 years old. We evaluated the clinical results using JOA score. The MRI findings were evaluated by using Spielmann criteria. The clinical results were analyzed statistically. The average JOA score improved from 54.9 points to 91.7 points postoperatively in the PG group and from 52.6 points to 90.7 points postoperatively in the PGA group. Many cases of the PGA group showed a slightly high intensity area in the repaired rotator cuff on MRI findings. In blood examination, the values of CRP were almost normalized with time by 3 weeks after surgery. There were no remarkable complications such as hydroarthrosis and destruction of bone tissues. We applied the PGA sheet for the purpose of repair of massive rotator cuff tear. The clinical results were preferable.
    抄録全体を表示
    PDF形式でダウンロード (343K)
  • 腱板部分断裂に対する鏡視下腱板修復術の臨床成績
    廣瀬 聰明, 野中 伸介, 上野 栄和, 木村 重治, 吉本 正太, 道家 孝幸, 岡村 健司
    2010 年 34 巻 3 号 p. 811-814
    発行日: 2010年
    公開日: 2010/11/16
    DOIhttps://doi.org/10.11296/katakansetsu.34.811
    ジャーナル 認証あり
    抄録を表示する抄録を非表示にする
    We performed arthroscopic rotator cuff repair (ARCR) with converting to a full-thickness tear for partial thickness rotator cuff tear (PRCT) grade 3 in Ellman's classification. The purpose of this study was to evaluate the clinical results of ARCR for PRCT. We retrospectively studied 38 patients (38 shoulders) who had received ARCR for PRCT which is classified into grade 3 in Ellman's classification and were followed up for more than 6 months. The patients were 19 males and 19 females. The mean age at operation was 63 years old (range, 36-79). The mean postoperative follow-up period was 14 months (range, 6-26). The clinical results were assessed using JOA scores and MRI by Sugaya's and Goutallier's classification.
    Tear size was <1cm tear in 15 shoulders, 1-3cm in 22 shoulders, and 3-5cm in 1 shoulder. The mean JOA total score was significantly improved from 65 points to 94 points postoperatively. The mean JOA pain score was significantly improved from 8 to 28, function score from 14 to 19, and ROM score from 24 to 27, respectively. Postoperative MRIs showed 2 type-3 shoulders in Sugaya's classification.
    The selection of surgical methods for PRCT is still controversial. In this study, the clinical results of ARCR with converting to a full-thickness tear for PRCT grade 3 was mostly satisfactory. But further long term follow up is necessary.
    抄録全体を表示
    PDF形式でダウンロード (319K)
  • 腱板修復術後の Knot Impingement
    永澤 雷太
    2010 年 34 巻 3 号 p. 815-819
    発行日: 2010年
    公開日: 2010/11/16
    DOIhttps://doi.org/10.11296/katakansetsu.34.815
    ジャーナル 認証あり
    抄録を表示する抄録を非表示にする
    We occasionally experienced some patients who feel awkward, uncomfortable with their shoulder state despite a full range of motion, enough muscle strength, and good cuff integrity of MRI. They had some characteristic signs of image; acromial erosion, enlargement of acromio-humeral interval of X-ray, no re-tear but effusion of the subacromial space in MRI. We hypothesized these phenomenon and signs were the cause of knots. We thought that mechanical impingement between acromion and knots, and chemical influence of thread maybe the cause. We operated on these patients again and removed knots and free threads. They showed obviously improvement.
    The purpose was to investigate the cause of knot impingement, the relationship between knots and acromial erosion, tear size, suture technique, the kind of thread, and so on. From Aug. 2002, we operated on rotator cuff tears with suture anchor technique in 569 shoulders. We used X-ray, MRI and 3DCT to understand the morphology of acromion correctly. We re-operated in10 shoulders.
    Knot impingement and acromial erosion were confirmed in 39%. Some following characteristic points have been confirmed. High risk group is smaller size and bursal side partial tear of rotator cuff, younger patients who need high activity, used high strength suture at lateral row. Low risk group is patients who had limitation of ROM, performed bridging suture technique and re-tear patients.
    There may be a possibility of cause being high strength suture. It is important that physicians select and consider suture methods, kind of anchors, threads and patient's background.
    抄録全体を表示
    PDF形式でダウンロード (577K)
  • Suture-Bridge法術後における骨孔の変化
    - 経時的MRIでの検討 -
    橋元 球一, 小松 尚, 柿崎 陽平, 秋田 護, 岩崎 哲也, 伊藤 淳二
    2010 年 34 巻 3 号 p. 821-823
    発行日: 2010年
    公開日: 2010/11/16
    DOIhttps://doi.org/10.11296/katakansetsu.34.821
    ジャーナル 認証あり
    抄録を表示する抄録を非表示にする
    Metallic anchors have recently replaced bioabsorbable anchors for use in arthroscopic rotator cuff repair. Drill hole enlargement has been reported, but only a few studies have assessed the drill hole by magnetic resonance imaging (MRI). Our purpose is to evaluate drill hole enlargement by serial MRI after arthroscopic rotator cuff repair using Panalok loop RC anchors® (Mitek), which are constructed with a poly-L-lactide acid polymer. Twenty patients (11 males, 9 females), who underwent the suture bridge technique from November 2007 until November 2008 were included. The drill hole was established at the foot print (diameter, 2.9 mm; depth, 18 mm). A coronal plane MRI was taken 1, 3, 6, and 12 months post-operatively, and three mean points were measured by quartering the anchor hole on T1-weighted image (T1WI). The mean patient age was 64.7 years old (range, 51 to 77). All patients were examined by MRI 1 month post-operatively; 15 patients at 3 months, 11 patients at 6 months, and 16 patients at 12 months. Seven patients were examined four times. At 1 month post-operatively, T1WI revealed that the drill hole was significantly smaller compared with 3 months later (4.8 mm vs. 4.3 mm, p < 0.01), but it had not enlarged at 6 and 12 months (4.3 mm vs. 4.3 mm). The low-intensity circumference area in most drill holes by T1W1 changed in moderate-intensity, which was presumed to be a process of osteoplasty. The drill hole tended not to enlarge but was smaller 3 months post-operatively. MRI is useful for evaluation of the drill hole after surgery.
    抄録全体を表示
    PDF形式でダウンロード (312K)
  • 腱板断裂に合併した上腕二頭筋長頭腱障害
    - 固定か切離か？ -
    三好 直樹, 松野 丈夫, 末永 直樹, 大泉 尚美
    2010 年 34 巻 3 号 p. 825-828
    発行日: 2010年
    公開日: 2010/11/16
    DOIhttps://doi.org/10.11296/katakansetsu.34.825
    ジャーナル 認証あり
    抄録を表示する抄録を非表示にする
    Injuries of the long head of the biceps tendon (LHB) are often associated with rotator cuff tears and are the cause of shoulder pain after rotator cuff repair. The purpose of this study is to evaluate the clinical and radiographic results of biceps tenodesis and tenotomy for injuries of LHB with rotator cuff tear. There were 35 shoulders that were treated with biceps tenodesis or tenotomy randomly for injuries of LHB with rotator cuff repair and followed-up over 1 year. We separated and evaluated the technique of sutured to soft-tissue (Group S) and placed into the bone socket of the bicipital groove with anchor (Group A), concerning biceps tenodesis. There were 12 shoulders (6 Males, 6 Females: average age 67.7 years old) in Group S of tenodesis, 13 shoulders (9 males, 4 Females: average age 61.1 years old) in Group A of tenodesis, and 10 shoulders (3 males, 7 Females: average age 65.1 years old) in Group tenotomy. Clinical features and surgical results of the 3 groups were evaluated using JOA score, ROM (flex, ER), existence of Popeye lesion and upward migration of humeral head on the A-P radiograph. There was no significant difference between the 3 groups in JOA score and ROM (flex, ER). There was only one patient in Group tenotomy who exhibited the Popeye lesion. Upper migration of the humeral head on X-ray was slightly apparent in only two cases in Group tenotomy. Clinical and radiographic results of both of biceps tenodesis and tenotomy for injuries of LHB with rotator cuff tear were satisfactory. We will investigate more patients and long term results for both of them.
    抄録全体を表示
    PDF形式でダウンロード (369K)
  • ノットレスアンカーを用いた
    腱板断端外側を縫合可能な鏡視下ブリッジングスーチャー法
    西川 英夫, 梅村 愛, 森澤 佳三
    2010 年 34 巻 3 号 p. 829-832
    発行日: 2010年
    公開日: 2010/11/16
    DOIhttps://doi.org/10.11296/katakansetsu.34.829
    ジャーナル 認証あり
    抄録を表示する抄録を非表示にする
    The purpose of this study was to evaluate the surgical results of arthroscopic rotator cuff repair (ARCR) using Bioknotless RC with Panalok Loop RC (modified bridging suture). We studied 15 patients (15 shoulders) who underwent ARCR (modified bridging suture) and were followed-up for more than 6 months from November 2007 to November 2008. Eleven were male and three were female. The average age was 64.4 years old (50-77 years old) and the average follow up period was 10.6 months (6-17 months). We investigated the surgical results using the Japanese Orthopaedic Association score (JOA score) and operation time. The tear type was incomplete and small in 0 shoulder, medium in 8 shoulders, large in 4 shoulders and massive in 3 shoulders. The average total JOA score increased from 53.4 points to 91.1 points after ARCR (modified bridging suture). The average operation time was 186 minutes (109-262 minutes). Surgical outcome of ARCR (modified bridging suture) was satisfactory.
    抄録全体を表示
    PDF形式でダウンロード (334K)
  • 肩腱板断裂に対するスーチャーブリッジ法による鏡視下腱板修復術
    国分 毅, 名倉 一成, 牧野 健, 池田 里砂, 豊川 成和, 乾 淳幸, 坂田 亮介, 西本 華子, 藤田 健司
    2010 年 34 巻 3 号 p. 833-836
    発行日: 2010年
    公開日: 2010/11/16
    DOIhttps://doi.org/10.11296/katakansetsu.34.833
    ジャーナル 認証あり
    抄録を表示する抄録を非表示にする
    Recently, the suture bridge technique, which is a surface holding method, was developed. The purpose of this study is to evaluate the clinical outcome of arthroscopic rotator cuff repair (ARCR) using suture bridge technique compared to dual row technique. Twenty one patients who under went ARCR were evaluated at 3 and 6 months postoperatively. Ten patients (male 6, female 4, average age 61.7 years old, average number of suture anchors 2.2) had ARCR with dual row technique performed (DR group), and the other eleven patients (male 5, female 6, average age 60.3 years old, average number of suture anchors 3.2) were repaired by suture bridge technique (SB group). The JOA score and range of motion were assessed, and the cuff integrity was evaluated by MRI. Total JOA score increased significantly in both the DR group and the SB group. The average total JOA score increased from 72.1 to 90.3 in SB group and from 68.3 to 87.4 in DR group at 6 months postoperatively. The range of motion was also increased in both groups. There was no significant difference between the two groups postoperatively and both groups showed excellent clinical outcomes. The cuff integrity of the SB group was better than that of the DR group. The clinical results of the suture bridge technique were satisfactory compared with the dual row technique. In our suture bridge method, it is difficult to compress the end of the tendon to the footprint using the sutures, however it is effective in terms of reproduction of the cuff integrity.
    抄録全体を表示
    PDF形式でダウンロード (329K)
  • Suture-Bridge 法を用いた鏡視下腱板縫合術後経時的 MRI の検討
    小松 尚, 橋元 球一, 秋田 護, 岩崎 哲也, 伊藤 淳二
    2010 年 34 巻 3 号 p. 837-840
    発行日: 2010年
    公開日: 2010/11/16
    DOIhttps://doi.org/10.11296/katakansetsu.34.837
    ジャーナル 認証あり
    抄録を表示する抄録を非表示にする
    Magnetic Resonance Imaging (MRI) is one of the helpful methods to evaluate the repaired rotator cuff. But one problem of MRI is the halation of the metallic anchors and it is difficult to evaluate foot print and anchor hole. From 2007 we had been operating, performing rotator cuff repair with arthroscopic suture-bridge technique using Panalok loop RC anchors (Mitek) which are constructed with a poly L lactate polymer. We prospectively evaluated the healing process of the repaired rotator cuff and foot print by serial MRI after rotator cuff repair. Twenty patients could be evaluated by serial MRI. The Suture-bridge technique used four panalok loop RC anchors, and fixed these, two anchors at the medial side, and the other two anchors at the lateral side of the foot print. Serial MRI were taken 1,3,6 and 12 months post-operatively. The repaired rotator cuffs and foot print were evaluated on T1-weighted MRI (T1W) and on T2-weighted MRI (T2W). The subjects are 11 males, and 9 females, and their average age was 64.7 years old (51-71). T1W revealed that bone edema of the foot print had been observed in 90% of cases at first examination (1month) and decreased to 20% 3months postoperatively, and bone formation had been examined in the anchor holes 87% cases at 3 months postoperatively, T2W revealed that half of the repaired rotator cuffs had been high intensity at 1,3 months postoperative examination (58%, 33%), and decreased at 6, 12 months(17%, 7%) and low intensity increased at 6, 12 months (33%, 53%). And T2W revealed the clear low density rim on the foot print at 6 months (80%), which could be the remodeling of the tendon-bone junction.
    抄録全体を表示
    PDF形式でダウンロード (369K)
  • 一次修復不能な腱板広範囲断裂に対する大腿四頭筋腱を用いたパッチ法
    福田 昇司, 西山 武, 大森 貴夫
    2010 年 34 巻 3 号 p. 841-845
    発行日: 2010年
    公開日: 2010/11/16
    DOIhttps://doi.org/10.11296/katakansetsu.34.841
    ジャーナル 認証あり
    抄録を表示する抄録を非表示にする
    Patch graft with fascia lata is one of the most common surgical options for irreparable massive rotator cuff tears, but fascia lata is thinner than rotator cuff tendon. We presented a new patch graft procedure with quadriceps tendon (QT). The surgical procedures were described in detail and our preliminary results were reported.
    From March 2005 to March 2009, we treated 111 rotator cuff tears surgically. Arthroscopic cuff repair was performed in 87cases, open repair in 8 cases, patch graft in 14 cases, and arthroscopic partial repair in 2 cases.
    QT patch graft was performed in 11 cases. Cuff reparability was evaluated by standard arthroscopic examinations. Subacromial decompression was done as needed. The size of the defect was measured and QT was harvested. In the first 5 cases QT was harvested with a bone plug and fixed by transosseus suture through a bone tunnel. After the 6th case, free QT was harvested without bone plug and fixed to the greater tuberosity with suture anchors.
    The mean operation time was 196.7min (144 ∼ 287min). 8 cases were available for clinical evaluation at least 6 months after surgery. The mean JOA score was improved from 62.5 points preoperatively to 88.3 points postoperatively. Postoperative MRI was available in 7 cases. Postoperative MRIs showed 5 type II, 1 type III, and 1 type IV according to Sugaya's classification.
    QT graft is thicker than fascia lata and similar to normal rotator cuff. QT without bone plug had morbidity on the donor site and is suitable for elderly patients.
    抄録全体を表示
    PDF形式でダウンロード (599K)
  • 鏡視下肩甲下筋腱修復術の治療経験
    野中 伸介, 廣瀬 聰明, 木村 重治, 上野 栄和, 吉本 正太, 道家 孝幸, 岡村 健司
    2010 年 34 巻 3 号 p. 847-851
    発行日: 2010年
    公開日: 2010/11/16
    DOIhttps://doi.org/10.11296/katakansetsu.34.847
    ジャーナル 認証あり
    抄録を表示する抄録を非表示にする
    The purpose of this study was to evaluate clinical outcomes of arthroscopic repairs of rotator cuff tears involving the subscapularis (SSC) tendon. Between January 2006 and September 2008 we treated 139 cases of rotator cuff tears (RCTs). Among them, 49 cases (35%) showed partial or complete subscapularis tendon tears. The arthroscopic rotator cuff repairs were performed in 13 of 49 cases. In the 13 cases, the average age at operation was 68.3 years old. The mean pre-operation period was 14.4 months. The tear size was classified by the longitudinal distance and the tendon retraction during arthroscopic surgery. In the longitudinal distance, the superior one-third of the footprint was torn in 7 cases, the superior two-thirds of the footprint in 6 cases. In the tendon retraction, there were 9 cases between lateral articular margin and the glenoid surface, 4 over the glenoid surface. We arthroscopically repaired RCTs by using the double-row technique. The clinical preoperative and postoperative assessment was performed using the JOA score, range of motion, the lift off test, and the belly press test. Their results improved significantly. The MRI assessment at 6 months after the surgery was performed on repair integrity according to Sugaya's classification. Type I and II was detected in 7 cases, type III in 4. Postoperative MRI findings showed no re-tear of SSC. The MRI assessment compared the repair integrity and the preoperative tear size, the fatty infiltration. The type III by Sugaya's classification was detected in 3 cases when the tear size was larger and the fatty infiltration stage by Goutallier's classification was stage III. In conclusion, the clinical and structural outcomes of arthroscopic repairs of rotator cuff tears involving the SSC were satisfactory. The preoperative tear size and fatty infiltration of the SSC tears might affect the postoperative repair integrity.
    抄録全体を表示
    PDF形式でダウンロード (492K)
  • 肩甲下筋腱完全断裂に対する重層固定法を用いた鏡視下手術成績
    河合 伸昭, 菅谷 啓之, 高橋 憲正, 萩原 嘉廣, 戸野塚 久紘, 立原 久義, 寺林 伸夫, 森石 丈二
    2010 年 34 巻 3 号 p. 853-856
    発行日: 2010年
    公開日: 2010/11/16
    DOIhttps://doi.org/10.11296/katakansetsu.34.853
    ジャーナル 認証あり
    抄録を表示する抄録を非表示にする
    [Purpose] The purpose of this study was to evaluate structural integrity and clinical outcomes after arthroscopic double-row repair for full-thickness subscapularis tendon tears. [Material and Method] From Mar. 2005 through Sept. 2008, 32 patients underwent arthroscopic double-row repair. The patients, 22 males and 10 females, with an average age of 62.5 (40-75) years old at the time of their surgeries were included. The mean postoperative follow-up period was 20.2 (12-54) months. Surgery was performed in beach chair position. The anterosuperior portal was mainly utilized for a viewing portal. Anatomical footprint reconstruction was performed using two or three anchors. The anchors were placed in a triangular position, making the superior side broader, to reconstruct the anatomical insertion. And the cord-like structure (comma), which connects to the superolateral border of subscapularis tendon, was preserved and used to achieve a strong and anatomical repair. The clinical evaluation was performed using the JOA shoulder score, UCLA score. The repair integrity using MRI T2-weighted imaging was evaluated at 1 year after surgery. [Result] JOA shoulder score was improved from 77.8 to 91.4, UCLA score was also improved from 20.6 to 34.2. According to the Sugaya's classification Postoperative MRIs revealed 15 type1, 9 type2, 5 type3, 0 type4 and 3 type5. [Conclusion] Arthroscopic double-row repair by using comma for full-thickness subscapularis tendon tear yielded successful functional outcomes and resulted in structural outcomes.
    抄録全体を表示
    PDF形式でダウンロード (429K)
  • ニコチンがラット棘上筋腱の物質特性に及ぼす影響
    一瀬 亮吾, 佐野 博高, 井樋 栄二, 坂元 尚哉, 佐藤 正明
    2010 年 34 巻 3 号 p. 857-860
    発行日: 2010年
    公開日: 2010/11/16
    DOIhttps://doi.org/10.11296/katakansetsu.34.857
    ジャーナル 認証あり
    抄録を表示する抄録を非表示にする
    Several studies have shown that nicotine has a detrimental effect on the development of rotator cuff tears. However, little has been known about its mechanism. The purpose of this study was to evaluate the effect of nicotine on the material properties of the supraspinatus tendon in a rat model. Twenty-seven rats were randomly assigned to three groups. Subcutaneously implanted osmotic pumps delivered two different concentrations of nicotine solution (high dose, 45 ng/ml: low dose, 22.5 ng/ml) or saline solution (controls) over a twelve-week period. The level of serum cotinine, a breakdown product of nicotine, was evaluated. Tensile testing was performed using the left supraspinatus tendon in each rat. The maximum load of the supraspinatus tendon was measured, and the maximum tensile stress and elastic modulus were calculated.
    Serum cotinine levels demonstrated controlled systemic release of nicotine. The maximum tensile load and stress did not show any significant differences among the three groups. However, the elastic modulus was higher in the nicotine groups than in the control group. A significant difference existed between the low-dose nicotine and control groups (P = 0.042). Nicotine caused a change in the material properties of the supraspinatus tendon in a rat model. This change, caused by nicotine administration, may be related to an occurrence of a tear in the supraspinatus tendon.
    抄録全体を表示
    PDF形式でダウンロード (414K)
神経疾患
  • 長胸神経 • 前鋸筋の解剖と臨床
    浜田 純一郎, 小川 清久, 秋田 恵一
    2010 年 34 巻 3 号 p. 861-865
    発行日: 2010年
    公開日: 2010/11/16
    DOIhttps://doi.org/10.11296/katakansetsu.34.861
    ジャーナル 認証あり
    抄録を表示する抄録を非表示にする
    The purposes of this study were (1) to clarify the trajectory of the long thoracic nerve (LTN), (2) to investigate the anatomy and innervations of the 3 parts of the serratus anterior (SA), and (3) to analyze clinical features of 450 shoulders with LTN palsy. We collected specimens from 70 sides of 35 cadavers. The LTN consisted of C5, C6, and C7 in 87% of sides, C5 and /or C6 penetrated the scalenus medius in 64 dissections, and descended for 24 cm posterolateral thorax. The upper part of the SA tilted the scapula anteriorly, the middle abducted, and lower rotated upwardly. The affected sides were right in 337 shoulders, left in 77, and both in 5. Symptoms of LTN palsy were various: pain; weakness; unable to elevate; numbness; not being able to sleep on the affected side; and instability overhead. The 3 critical points of The LTN have been documented in the literature: in the scalenus medius; on the 2nd rib; and the fibrous band beneath the brachial plexus. Surgical treatment of LTN palsy identified the exit of the SA as the true entrapment point of the nerve. The outcome of surgical intervention was better than that of conservative treatment, therefore, decompression of the nerve is recommended as an interventional option of LTN palsy.
    抄録全体を表示
    PDF形式でダウンロード (639K)
  • 鏡視下上肩甲横靭帯切離術の臨床成績と MRI による筋萎縮の評価
    大泉 尚美, 末永 直樹, 船越 忠直, 山口 浩, 三浪 明男
    2010 年 34 巻 3 号 p. 867-871
    発行日: 2010年
    公開日: 2010/11/16
    DOIhttps://doi.org/10.11296/katakansetsu.34.867
    ジャーナル 認証あり
    抄録を表示する抄録を非表示にする
    We have performed arthroscopic release of the suprascapular nerve (SSN) in patients with sensory disturbance of the SSN area since 2006. The purpose of this study is to investigate the clinical outcome and postoperative change of the supraspinatus and infraspinatus muscle atrophy using MRI. Twenty shoulders (10 men and 10 women, average age: 63.8 years (range, 41-77)) were followed for more than 1 year and included in this study. Associated diagnoses were 14 cuff tears (5 incomplete tears, 3 medium tears, 2 large tears, and 4 massive tears), 2 frozen shoulders, 3 rheumatoid arthritis, and 2 cuff tear arthropathy. For these conditions, additional procedures (5 ARCR, 6 ORCR, 3 humeral head replacement, 1 ASD, and 2 TSA) were performed simultaneously. JOA score and sensory disturbance were evaluated pre- and postoperatively. To evaluate muscle atrophy, the occupation ratio (OR) of supraspinatus and infraspinatus was measured in sagittal view of MRI. More than 10% increase of postoperative OR was defined as improvement; more than 10% decrease as progress. The follow-up period was 12-30 months (avg. 18.5). JOA score improved from 51.1 to 90.5 points postoperatively. The sensory disturbance disappeared postoperatively in all shoulders. In the supraspinatus, preoperative OR was more than 75% in 1 shoulder, 50-75% in 7, and 25-50% in 12; in the infraspinatus, more than 75% in 8 shoulders, 50-75% in 8, 25-50% in 3, and less than 25% in 1. Postoperative OR of the supraspinatus improved in 8 shoulders (40%) and progressed in 2; postoperative OR of the infraspinatus improved in 6 (30%) and progressed in 2. The sensory disturbance and pain improved in all shoulders. Improvement of muscle atrophy was observed even in shoulders with severe atrophy (OR < 50%) in the supraspinatus. Arthroscopic release of SSN is considered useful in improvement of not only pain and sensory disturbance but also muscle atrophy.
    抄録全体を表示
    PDF形式でダウンロード (512K)
その他
  • 投球障害肩の危険因子としての筋疲労と関節位置覚低下
    田崎 篤, 山川 晃, 森田 亘, 星川 吉光
    2010 年 34 巻 3 号 p. 873-877
    発行日: 2010年
    公開日: 2010/11/16
    DOIhttps://doi.org/10.11296/katakansetsu.34.873
    ジャーナル 認証あり
    抄録を表示する抄録を非表示にする
    An excessive number of pitches, disarrayed pitching forms and fatigue of shoulder muscles are known to be risk factors of shoulder disorders after pitching. Although the evidence of shoulder pain in throwing athlete is little, limiting the number of pitches and securing an appropriate interval is suggested for injury prevention. We evaluated the fatigue of shoulder muscles and the change of proprioception quantitatively in pitching. Eleven high-school pitchers were intended in a prospective study. A hand-held dynamometer was used to evaluate the peri-shoulder muscle strength bilaterally (dominant side: DS, non-dominant side: NDS) in 7 directions, and the shoulder joint proprioception was evaluated in 6 directions before and after pitching. Wilcoxon's signed rank test was used. The basic muscle strength before pitching was higher at DS except in the empty can test. There was a significant strength reduction in the empty can test, flexion and internal rotation at DS after pitching in comparison with NDS. There was a significant false recognition at abduction external rotation 30 degrees and 90 degrees after pitching on D. The reduced strength in the empty can test of D suggested a potential superior rotator cuff damage by pitching. The internal rotators were lead to fatigue by repetitive eccentric contraction at the late cocking phase and concentric contraction at acceleration. These differences in exhaustion of the internal and external rotators influenced the sensors which lead to the misconception of the position sense. Individual regular examination of muscular strength and propriocepsion is considerable method to decide an appropriate pitching interval and number for a prevention of throwing shoulder injury.
    抄録全体を表示
    PDF形式でダウンロード (628K)
  • 大学野球選手における無症候期の両肩関節 MRI 所見
    石井 壮郎, 向井 直樹, 宮川 俊平
    2010 年 34 巻 3 号 p. 879-883
    発行日: 2010年
    公開日: 2010/11/16
    DOIhttps://doi.org/10.11296/katakansetsu.34.879
    ジャーナル 認証あり
    抄録を表示する抄録を非表示にする
    It is useful to know the condition of asymptomatic shoulders of baseball players in order to prevent throwing shoulder injury. But there are few reports about MRI of asymptomatic shoulders of baseball players. In this study, we investigated MRI findings of bilateral shoulders of asymptomatic collegiate baseball players.
    The subjects are 48 collegiate baseball players without symptoms. We compared the difference between throwing and non-throwing shoulders by MRI. The mean age of the playrers was 19.5(18-22) years old. The mean years of baseball experience were 10 ± 1.5 years. They underwent conventional MRI in adduction and in the ABER position. The following pulse sequences were used a) SE-T1WI b) FSE-T2WI. We assessed MRI signal abnormalities and deformities in their humeral head, glenoid, rotator cuff and subacrominal bursa.
    52% of their humeral heads of throwing side had abnormal findings more than the non-throwing side(11%). 65% of their glenoids of throwing side had abnormal findings more than non-throwing side(10%). 48% of their rotator cuff tendons of throwing side had abnormal findings more than non-throwing side(4%). 33% of subacrominal bursa of throwing side had abnormal findings more than non-throwing side(12%). The distribution and patterns of these findings were similar to those which have been reported as throwing injury in symptomatic shoulders.
    We think it is important to prevent throwing shoulder injury at an early stage because we could find lesions already in the asymptomatic phase.
    抄録全体を表示
    PDF形式でダウンロード (427K)
  • 無症候期の肩 MRI 所見から投球肩障害の発症を予測できるか？
    石井 壮郎, 向井 直樹, 宮川 俊平
    2010 年 34 巻 3 号 p. 885-889
    発行日: 2010年
    公開日: 2010/11/16
    DOIhttps://doi.org/10.11296/katakansetsu.34.885
    ジャーナル 認証あり
    抄録を表示する抄録を非表示にする
    We reported that many collegiate baseball players had abnormal MRI findings in asymptomatic phase. But it is not clear which findings are relative to the onset of throwing shoulder injury, in other words which findings are harmful lesions and which are just adaptations. The purpose of this study is to identify the findings as the lesion which affects consecutive onset and to calculate a regression formula which could predict the future onset, and we discussed the prevention strategy. Prospective study. The subjects were 48 asymptomatic collegiate baseball players. They underwent conventional MRI and we investigated who got shoulder injury during this year. We did logistic regression analysis with MRI findings and the data of the onset and found out the factors which significantly affected the onset. We also calculated Odds ratio of these factors and regression formula which predict the probability of the onset of shoulder injury and evaluated the regression model. 50%(24/48 cases) of the players suffered throwing shoulder injury during this year. Among the MRI findings of asymptomatic phase, humeral head edema and subacrominal bursitis around coraco-acrominal ligament were thought to be the lesions which are near-related to the onset of throwing shoulder injury. We calculated regression formula using MRI findings of asymptomatic phase and we could predict the onset of throwing shoulder injury with 82% accuracy. In order to prevent throwing shoulder injury, it is important to solve the mechanism of how these lesions above occur and develop the means to prevent the occurrence of these lesions above. The method used in this study is useful to predict the onset of throwing shoulder injury.
    抄録全体を表示
    PDF形式でダウンロード (530K)
  • 投球による腋窩神経障害の発生状況
    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. 891-894
    発行日: 2010年
    公開日: 2010/11/16
    DOIhttps://doi.org/10.11296/katakansetsu.34.891
    ジャーナル 認証あり
    抄録を表示する抄録を非表示にする
    The purpose of this paper was to investigate the occurrence of axillary nerve lesion in throwing athletes. We studied 118 throwing shoulder cases. There were 100 males and 18 females with a mean age of 21.7 years old (range, 9-60). The diagnosis of an axillary nerve lesion was made, when the patient had hypesthesia in the distribution of axillary nerve and tenderness of the quadrilateral space or the axillary fossa. Hypesthesia was confirmed by both light touch with a brush (LT) and a cold sensation with alcohol cotton (CS). The range of motion of the shoulder was measured bilaterally. Plain radiographies or computed tomographies of the shoulder were studied to detect the Bennett lesions. Patients' age, shoulder ROM, and incidence of Bennett lesion were compared between the positive and the negative axillary nerve lesion groups. Axillary nerve lesions were observed in 100 of the 305 cases (32.4%). Regarding the sensory test of the axillary nerve, CS alone was positive in 81 cases (81%), both CS and LT were positive in 24 cases (24%), but there was no case of LT alone being positive. Bennett lesions were detected in 58 of the 305 cases (19%). In all of the patient's age, shoulder ROM, and incidences of Bennett lesions, there were no statistical differences between the positive and the negative axillary nerve lesion groups. We could get good effects in all of the 32 cases in which we performed an axillary nerve block. Two patients required arthroscopic Bennett spur resection and postero-inferior capsular release. Axillary nerve lesions were supposed to be relatively common problems in throwing athletes.
    抄録全体を表示
    PDF形式でダウンロード (538K)
  • 投球障害肩における関節鏡所見の検討
    ∼ 腱板関節面不全断裂の発生部位を決める因子の検討 ∼
    吉松 俊紀, 吉松 俊一, 望月 一成, 江田 誉, 吉松 千晶, 斎藤 明義, 龍 順之助
    2010 年 34 巻 3 号 p. 895-898
    発行日: 2010年
    公開日: 2010/11/16
    DOIhttps://doi.org/10.11296/katakansetsu.34.895
    ジャーナル 認証あり
    抄録を表示する抄録を非表示にする
    Articular-side partial rotator cuff tears are a common shoulder injury among throwing athletes. The internal impingement theory has recently been accepted as one of the most plausible explanations for the location of these injuries, however, the actual pathological mechanism is still unknown. In this study, we reported the outcome of arthroscopic examinations and discussed the pathology in symptomatic shoulders of overhead throwing athletes. Our hypothesis was that different pathological findings of the glenoid determine the location of articular-side partial rotator cuff tears. 41 shoulders which underwent arthroscopic surgery for throwing injuries from 2004 to 2008 were retrospectively investigated in this study. We observed the location of the rotator cuff tears (RCT), presence of the erosion and/or the deeper concavity around the anatomic bare patch, SLAP lesions, anterosuperior and posterosuperior labral injury, frilled posterosuperior labrum, skirt-like superior labrum. We compared several factors between anterior RCT and posterior RCT to investigate those related to the location of RCT. Isolated anterior RCT existed in 17%, isolated posterior RCT existed in 39%, combined RCT existed in 12%, and RCT was not observed in 32% of the patients. Therefore, we tried to clarify the mechanism of the anterior RCT and posterior RCT respectively. Anterior RCT occured from the contact between the anterior rotator cuff and the biceps labrum complex with type 2 SLAP lesion including a skirt-like labrum. Posterior RCT occured from the contact between the posterior rotator cuff and the frilled posterosuperior labrum. We conclude that different pathological findings of the glenoid determine the location of articular-side partial rotator cuff tears.
    抄録全体を表示
    PDF形式でダウンロード (795K)
  • ラット肩関節不動化モデルにおける表層軟骨細胞層の変化
    菅野 敦子, 佐野 博高, 井樋 栄二
    2010 年 34 巻 3 号 p. 899-902
    発行日: 2010年
    公開日: 2010/11/16
    DOIhttps://doi.org/10.11296/katakansetsu.34.899
    ジャーナル 認証あり
    抄録を表示する抄録を非表示にする
    Superficial Zone Protein (SZP)/ Lubricin is expressed by superficial zone chondrocytes, synoviocytes, and tenocytes. SZP is essential for boundary lubrication of joints. In some previous reports, SZP expression is up-regulated by shear stress. Stimulation by TGF- β1 also up-regulates SZP expression. We hypothesized that joint immobilization might induce the decrease of SZP expression, since shear stress might decrease. The aim is to investigate the number of superficial zone chondrocytes and mRNA expression in chondrocytes in humerus head; SZP, TGF- β1, type II collagen, and aggrecan. Extra-articular shoulder immobilization was performed in Sprague-Dawley 12-week-old male rats. To evaluate the cell number, histologic sections were made after 8-week immobilization (N = 6). The number of chondrocytes existing within 20μm depth was counted both in the contact area and non-contact area. To evaluate mRNA expression, chondrocytes were isolated from whole cartilage of the humeral head after 4-week immobilization. RNA was isolated and Quantitative real-time PCR assay was carried out (N = 8). In the statistical analysis, Student t-test was performed. In the immobilized group, the number of superficial zone chondrocytes decreased significantly only in the contact area. SZP and TGF- β1 mRNA expression decreased significantly in the immobilized group. Aggrecan expression increased significantly in the immobilized group. There was no significant difference between the two groups in type II collagen expression. In the current study, SZP expression was decreased in immobilized joints. We considered that immobilization reduced the SZP expression and a decrease in the number of chondrocytes. It was suggested that loss of shear stress induced this results. Decrease of TGF- β1 expression might be related to the decrease in SZP expression.
    抄録全体を表示
    PDF形式でダウンロード (313K)
  • 鏡視下腱板修復術後の RSD 様症状の予防
    石谷 栄一
    2010 年 34 巻 3 号 p. 903-906
    発行日: 2010年
    公開日: 2010/11/16
    DOIhttps://doi.org/10.11296/katakansetsu.34.903
    ジャーナル 認証あり
    抄録を表示する抄録を非表示にする
    We experienced some cases with RSD symptoms of wrist and finger after ARCR. Such cases tended to have a hard time in physical therapy. We performed two therapeutic exercises, and investigated about prevention of each RSD symptom and the difference of changing ROM. The control group who had only normal physical therapy was 26 cases. The finger group who had finger exercise added was 39 cases. The rotator cuff group who had rotator cuff exercise added was 30 cases. We examined the changes in passive elevation angles until post-operative three weeks. We evaluated RSD findings in score that each symptom of pain, skin change, swelling and contracture got one point. In the ratio of RSD score 1 & 2 & 3 & 4, the control group was 38.5% and the finger group was 23.1% and the rotator cuff group was 13.3%. In the ratio of RSD score 3 & 4, the control group was 15.4% and the finger group was 7.6% and the rotator cuff group was 0%. In the changes of elevation angle (pre-operation, post-operative one, two, three weeks), the control group was 133.8 degrees, 121.3 degrees, 136.9 degrees, and 145.2 degrees. The finger group was 138.7 degrees, 137.6 degrees, 148.6 degrees, and 151.4 degrees. The rotator cuff group was 140.8 degrees, 132.7 degrees, 147.0 degrees, and 153.5 degrees. The incidence of RSD symptoms decreased in comparison with the control group significantly in the finger group, and the rotator cuff group. We showed that finger therapeutic exercise and rotator cuff muscle exercise together were effective in preventing RSD symptom. We showed that the changes of elevation angle in the two self exercise groups were significantly improved earlier than in the control group for post-operative one and two weeks.
    抄録全体を表示
    PDF形式でダウンロード (439K)
  • 原テストによる少年野球選手のメディカルチェック：
    肘の疼痛及び障害との関連について
    吉田 雅人, 大藪 直子, 土屋 篤志, 後藤 英之, 武長 徹也, 冨田 眞壽生, 杉本 勝正
    2010 年 34 巻 3 号 p. 907-910
    発行日: 2010年
    公開日: 2010/11/16
    DOIhttps://doi.org/10.11296/katakansetsu.34.907
    ジャーナル 認証あり
    抄録を表示する抄録を非表示にする
    We evaluated baseball players in little league at medical check-ups including examination of shoulder joint, and elucidate the relationship between elbow disorders and Hara test. In this study, 75 baseball players in little league were evaluated form 2003 to 2006. The mean age of subjects was 11 years old ranging from 9 to 13. At medical check-ups, a specific medical examination (Hara's test)of the shoulder joint proposed by Hara's test was performed on each subject. The shoulder scores (total 11 points) by Hara's test in the group without elbow pain or elbow injury with throwing side averaged 8.6 points for the throwing side and 8.8 points for the non-throwing side. On the other hand, the shoulder scores in the other group with elbow pain or elbow injury averaged 7.0 points for the throwing side and 8.6 points for the non-throwing side. There were statistical differences between the throwing side in both groups. The significant relations between elbow pain or injury and Hara's test were as follows: SSc test; ISP test; elbow extension test (ET). The medical check-ups could provide a good opportunity for baseball players and coaches to understand the prevention of sports injuries.
    The specific test for shoulder joint was useful for detecting not only shoulder joint problems but also concealed elbow joint injury.
    抄録全体を表示
    PDF形式でダウンロード (350K)
治療法
  • 全人工肩関節置換術における上腕骨骨頭設置位置の X 線学的検討
    藤沢 基之, 柴田 陽三, 伊崎 輝昌, 熊野 貴史, 篠田 毅, 寺谷 威, 内藤 正俊
    2010 年 34 巻 3 号 p. 911-914
    発行日: 2010年
    公開日: 2010/11/16
    DOIhttps://doi.org/10.11296/katakansetsu.34.911
    ジャーナル 認証あり
    抄録を表示する抄録を非表示にする
    An account of primary osteoarthritis of the shoulder is not frequent in Japan. Clinical results for total shoulder arthroplasty are infrequently reported. The purpose of this study is to investigate radiographs after total shoulder arthroplasty in order to evaluate the positioning of components. Twenty-six cases of total shoulder arthroplasty were studied. These were 3 male and 23 female and their average age was 68.9 (41-83) years old. These diagnoses included 22 cases of osteoarthritis, 2 cases of rheumatoid arthritis and 2 cases of avascular necrosis of the humeral head. After 2008, in order to exactly set up the humeral component, a control radiograph was taken during the surgery immediately after inserting a metal trial head. We compared the measurement result between the group of having the radiograph examination during surgery and the group with no radiograph examination. We measured five parameters on the standardized anteroposterior shoulder radiograph after surgery according to Orfaly's study. The result of the average distance of acromial humeral head interval was 11.6 ± 3.9mm in all cases, was 10.9 ± 2.4 mm in the radiograph examination group and 12.4 ± 3.9 mm in the no radiograph examination group. The result of the average distance from the top of the humeral head to the top of the greater tuberosity (humeral head height) was 6.7 ± 2.8 mm in all cases, was 7.0 ± 2.1 mm in the radiograph examination group and 6.8 ± 3.0 mm in the no radiograph examination group. The previous reports recommended 5 to 10 mm of the humeral head height. Although the average height of the two groups is in between this range, a wider standard deviation was observed in the no radiographic examination group compared with that in the radiograph examination group. These results suggested reproducible set up of the humeral component is possible by using the intraoperative radiograph examination combined with the metal trial head.
    抄録全体を表示
    PDF形式でダウンロード (426K)
  • 肩鏡視下手術における術中揉み出し法の効果
    朝倉 透, 松浦 恒明, 進 訓央, 大江 健次郎
    2010 年 34 巻 3 号 p. 915-918
    発行日: 2010年
    公開日: 2010/11/16
    DOIhttps://doi.org/10.11296/katakansetsu.34.915
    ジャーナル 認証あり
    抄録を表示する抄録を非表示にする
    After arthroscopic surgery in shoulders we have much discharge in the gauze and often need to change it. In April 2007, we started a trial of milking shoulders to get perfusate out before closure of the wound. To judge the effects, we checked the surface of gauze the next morning. 196 patients (male; 114 cases, female; 82 cases) were underwent arthroscopic surgery on rotator cuff tears from January 2004 to May 2009 in our hospital. Average age at surgery was 63.9 years old. We compare the group of milking cases (98 cases after April 2007) to the non-milking cases (98 cases until May 2007). We found discharge over the gauze by the next morning in 12 cases (12.2%) of milking group and 25 cases (25.5%) of non-milking group. Our trial of milking a shoulder before closure of the wound is effective on the reduction of the postoperative discharge.
    抄録全体を表示
    PDF形式でダウンロード (365K)
  • 鏡視下腱板修復術後の疼痛コントロール法の比較
    濱浪 一則, 真鍋 博規
    2010 年 34 巻 3 号 p. 919-922
    発行日: 2010年
    公開日: 2010/11/16
    DOIhttps://doi.org/10.11296/katakansetsu.34.919
    ジャーナル 認証あり
    抄録を表示する抄録を非表示にする
    The aim was to assess alternative methods of post operative pain control with the continuous morphine injection and the continuous interscalene block in patients undergoing rotator cuff repair surgery. Forty-four patients were included in this study. Morphine (M) group consisted of 18 cases. Interscalene block (ISB) group consisted of 26 cases. All patients had interscalene block with 0.75%-ropivacane and 2% lidocane by single surgeon following induction of general anesthesia. In M group, glenohumeral joint injection with 20ml of 2% lidocane with epinephrine was administrated at the end of surgery and followed by postoperative injection of morphine (0.4-0.5mg/hr) and doroperidol (0.05-0.125mg/hr in cases of less than 70 years old). In group ISB, continuous interscalene block with 0.2%-ropivacane was administered. Data collected were the difference between systolic pressure, pain at recovery from anesthesia, the number of times that sharp pain appeared, number of pain medications, number of nighttime awakenings, and incidence of adverse effects. A total of 42 patients (95%) had a successful block. In M group, three patients had sharp pain at recovery from anesthesia. The number of times that sharp pain appeared was 3.0 ± 2.6 in M group and 1.3 ± 1.1in ISB group, the number of nighttime awakenings was2.4 ± 1.5, 1.8 ± 1.4 times, the number of patients vomiting was 5 (28%) and 2 (7.7%), respectively. No complications, including pneumothorax and nerve injury, were observed. Interscalene plexus block before surgery and continuous interscalene plexus block in the postoperative period has few side effects, and sharp pain control is possible.
    抄録全体を表示
    PDF形式でダウンロード (298K)
症例報告
  • 鏡視下に確認できた上腕二頭筋長頭腱破格の 1 例
    菊川 和彦, 奥平 信義
    2010 年 34 巻 3 号 p. 923-925
    発行日: 2010年
    公開日: 2010/11/16
    DOIhttps://doi.org/10.11296/katakansetsu.34.923
    ジャーナル 認証あり
    抄録を表示する抄録を非表示にする
    We report a rare case of a semi-professional baseball player who had anomaly of the long head of the biceps brachii. A 26-year-old male, who had a 17-year career of baseball felt a pain on his right shoulder in the cocking phase for throwing. Conservative treatments and no throwing for 4 weeks were not effective. Crank test and horizontal adduction test were positive. MR arthrography revealed joint side tear of rotator cuff. Arthroscopic examination revealed the long head of the biceps brachii was empty and no lesion of origin. Cord like tissues combined with deep layer of supraspinatous tendon, so we diagnosed anomaly of the long head of the biceps brachii. Debridement was performed to joint side tear of the rotator cuff. Postoperatively, there was good pain relief and he returned to baseball game. We consider anomaly of the long head of the biceps brachii caused muscle unbalance and internal impingement. This case was first reported when arthroscopic examination revealed long head of the biceps brachii was empty and no lesion of origin.
    抄録全体を表示
    PDF形式でダウンロード (279K)
  • 鏡視下腱板疎部縫縮術を行なった外傷性肩関節前下方亜脱臼の 1 例
    横田 淳司
    2010 年 34 巻 3 号 p. 927-930
    発行日: 2010年
    公開日: 2010/11/16
    DOIhttps://doi.org/10.11296/katakansetsu.34.927
    ジャーナル 認証あり
    抄録を表示する抄録を非表示にする
    Studies have shown the effect of plication of rotator interval (RI) capsule on the stability of the glenohumeral joint. We reported a case of traumatic chronic antero-inferior shoulder subluxation treated by arthroscopic RI plication (ARIP) procedure. A 13 year-old female had pain in her left shoulder when she fell on her outstretched arm. Immediately she visited a hospital and had an X-ray examination which was diagnosied as shoulder subluxation, but she underwent only prescription of anti-inflammatory medicine. She was referred to our hospital 22 days after injury. She had severe pain and limitation of motion in her left shoulder, but did not have any neurological abnormality, general joint laxity or instability of the contralateral side. The X-rays revealed antero-inferior subluxation. MR arthrography showed pooling of the contract medium around the antero-superior corner of the shoulder and stress X-rays showed inferior instability diminished in the shoulder external rotation position, indicating slack of RI was thought to be the essential lesion for this shoulder subluxation. 5 weeks after injury she underwent surgical treatment. Arthroscopic examination revealed redness and zig-zag shaped tear of synovium in RI but no lesions in the anterior shoulder labrum or midsubstace tear of glenohumaral ligament were observed. We performed ARIP procedure. Postoperatively, congruity of the GH joint was improved and anterior instability was markedly decreased: therefore temporary transarticular fixation was not performed. The arm was immobilized with a Velpeau bandage for 3 weeks and subsequently active-assist exercises were initiated. 2 years after surgery, she had no pain and no recurrence of shoulder subluxation. One year after surgery, her left shoulder was stable in full range of motion.
    Efficacy of ARIP procedure for patients with loose shoulder and throwing injury has been reported. In our case, the short-term result of the ARIP procedure for traumatic chronic antero-inferior shoulder subluxation is favorable.
    抄録全体を表示
    PDF形式でダウンロード (373K)
  • 外傷性肩関節後方脱臼に対する骨移植併用小結節移行術の経験
    太田 悟
    2010 年 34 巻 3 号 p. 931-934
    発行日: 2010年
    公開日: 2010/11/16
    DOIhttps://doi.org/10.11296/katakansetsu.34.931
    ジャーナル 認証あり
    抄録を表示する抄録を非表示にする
    We experienced the case that was a chronic example of traumatic shoulder posterior dislocation and used bone graft together with lesser tubercle migration technique because of massive bone defect. A 59-year-old man, stretched the right arm under a pillar which ran along in the ceiling and got shocked when wiring worked. After injury, six weeks later, he came to this hospital. In axis X-ray and CT, the head of the humerus was posterior locked dislocated in the glenoid cavity. The cartilage defect rate of the humerus head was more than 40%. Because the humeral head was locked in the rear of the glenoid, noninvasive closed reduction was difficult and we opted for an open reduction operation. We tried the reduction by limb traction and internal rotation. It was easy to dislocated to the posterior even after the repositioning because of massive bone defect. We then performed free bone graft on the defective part of the bone and lesser tubercle migration. JOAscore was good with 96 points ten months postoperative. Treatment plan of posterior dislocation is decided on the size of the bone defect and dislocation period. As for this case, bone defects exceeded 40%, arthroplasty was difficult only by conventional lesser tubercle migration technique. Bone cartilage piece is present in the lesser tubercle lower part and this was transplanted in the defective part of the bone and we shifted and filled up the defect with the lesser tubercle which attached to the subscapularis tendon and formed an articular surface. After operation, adaptability of the articular surface became good.
    抄録全体を表示
    PDF形式でダウンロード (475K)
  • 反復性肩関節脱臼を生じた Parkinson 病の 2 例
    根津 悠, 高橋 晃, 上石 貴之, 松本 里沙, 齋藤 知行
    2010 年 34 巻 3 号 p. 935-938
    発行日: 2010年
    公開日: 2010/11/16
    DOIhttps://doi.org/10.11296/katakansetsu.34.935
    ジャーナル 認証あり
    抄録を表示する抄録を非表示にする
    Two cases of Parkinson's disease(PD) with recurrent dislocation of the shoulder causing a large bone defect at the humeral head and permanent dislocation were reported. Case 1 was a 74-year-old woman with PD. First dislocation of her right shoulder occurred with no major trauma. Dislocation of the shoulder occurred three times after the first visit. Finally, a large bone defect was observed at the humeral head and the dislocated humeral head was impacted at the anteroinferior rim of the glenoid. Her shoulder pain gradually became stronger. Operation was performed for the purpose of relief of pain. The humeral head was resected and a subscapularis tendon was interposed into the glenohumeral joint using two metal anchors. At the final follow-up, active elevation showed 60 degrees and ADL was limited, but the preoperative shoulder pain decreased. Case 2 was a 75-year-old woman with PD. First dislocation of her right shoulder occurred by falling down forwards. Dislocation of the shoulder was occurred six times after the first visit. Finally, this dislocation was hard to manually reduce and conservative therapy was performed. A large bone defect was observed at the humeral head and the dislocated humeral head was impacted at the anteroinferior rim of the glenoid. Her shoulder pain gradually decreased. At the final follow-up, active elevation decreased 70 degrees and ADL was limited. But the pain gradually decreased by conservative therapy. The dislocations and fractures of the shoulder often occurred in patients with PD due to akinesia,postual instability, muscle weakness and osteoporosis. First dislocation can easily develop into recurrent and permanent dislocation of the shoulder caused by the difficulty of reduction due to rigidity and resting tremor. Resection arthroplasty and conservative therapy were performed. ROM of the shoulder and ADL were limited, but severe shoulder pain was relieved.
    抄録全体を表示
    PDF形式でダウンロード (410K)
  • 関節窩後方に剥離骨片を認めた外傷性肩関節後方不安定症の1例
    岩田 圭生, 森原 徹, 本多 宏明, 堀井 基行, 久保 俊一, 黒川 正夫
    2010 年 34 巻 3 号 p. 939-942
    発行日: 2010年
    公開日: 2010/11/16
    DOIhttps://doi.org/10.11296/katakansetsu.34.939
    ジャーナル 認証あり
    抄録を表示する抄録を非表示にする
    Recurrent posterior instability of the shoulder is a relatively rare condition and remains a challenge to treat surgically. A posterior shoulder instability with reverse osseous Bankart lesion is rare. There have been only a few reports in the literature. A case of a posterior shoulder instability with reverse osseous Bankart lesion in a college football player was reported. He felt pain and an unstable feeling in his left shoulder at tackle or during bench press following a traumatic accident in a football game. He had posterior apprehension, pain with posterior stress, and a characteristic “jerk” test with the arm at 90° of forward elevation and internal rotation. 3D-CT revealed a reverse osseous Bankart lesion, osseous avulsion fracture at the posterior aspect of the glenoid rim at the insertion of the posterior band of the inferior glenohumeral ligament. Magnetic resonance arthrography showed a redundancy of the posteroinferior capsule and increased joint volume. Posterior labral repair and superior shift of the posteroinferior aspect of the capsule were done with use of two suture anchors in an arthroscopic procedure. His shoulder was immobilized with a sling for 3 weeks. He was allowed to return to full competition at 6 months after surgery. At 2-years after the surgery, he had a stable shoulder and was able to return to football activities with no limitation. Arthroscopic procedures for a traumatic unidirectional posterior shoulder instability with reverse bony Bankart lesion provide satisfactory results.
    抄録全体を表示
    PDF形式でダウンロード (319K)
  • 著明な骨頭内反転位を呈した上腕骨近位端骨折後偽関節の一例
    新村 光太郎, 高瀬 勝己, 山本 謙吾
    2010 年 34 巻 3 号 p. 943-946
    発行日: 2010年
    公開日: 2010/11/16
    DOIhttps://doi.org/10.11296/katakansetsu.34.943
    ジャーナル 認証あり
    抄録を表示する抄録を非表示にする
    A-62-year old woman fell down and received a hard blow on her right shoulder. Pain and restriction of shoulder motion continued for about 18 months in spite of conservative treatment under a diagnosis of humeral surgical neck fracture (2 parts) at a previous hospital. When she consulted us, her range of motion in the right shoulder was restricted to 70 degree flexion and 20 degree external rotation. Radiographs and computed tomography showed proximal humeral pseudoarthrosis with highly varus displacement of humeral head fragment. The varus angle was over 90 degree. A hemiarthroplasty was performed 24 months after the trauma. Greater and lesser tuberosities were separated from the humeral head fragment, and adhesion of rotator cuff was stripped in full to pull out. The stem height establishment was arranged in consideration of muscle balance. After the operation, ultrasonic therapy (LIPUS) was performed at an early stage, and the shoulder was immobilized in the slight abducted position for 6 weeks. For the present, she has no pain, and her range of motion is 120 degree flexion and 30 degree external rotation.
    抄録全体を表示
    PDF形式でダウンロード (390K)
  • 上腕骨近位端骨折に PHILOS を用い遷延治癒を呈した3例の検討
    松田 雅彦, 後藤 康夫
    2010 年 34 巻 3 号 p. 947-949
    発行日: 2010年
    公開日: 2010/11/16
    DOIhttps://doi.org/10.11296/katakansetsu.34.947
    ジャーナル 認証あり
    抄録を表示する抄録を非表示にする
    The aim of this study is to clarify the complications of PHILOS for proximal humeral fracture. [Case 1] A 58-year-old woman fell, and was diagnosed as having 3-part fracture by Neer classification. Open reduction and internal fixation was done with PHILOS. There were 7 locking screws in the proximal side and 3 screws in the distal side. The stability was rigid. After four months, we diagnosed delayed union, so ultrasound stimulation was carried out. Finally bone union was obtained, but partial osteonecrosis of the humeral head existed. JOA score was 78 points. [Case 2] A 58-year-old woman was diagnosed as having 4-part fracture. Operation was done using PHILOS, 9 locking screws were in the proximal side and 3 screws were in the distal side. The stability was rigid. After four months, we diagnosed delayed union, so ultrasound stimulation was carried out. JOA score was 88 points. [Case 3] A 78-year-old woman was diagnosed as having 3-part fracture. Operation was done using PHILOS, 7 locking screws were in the proximal side and 3 screws were in the distal side. The stability was rigid. We diagnosed delayed union at five months postoperatively.
    Too rigid fixation using PHILOS sometimes causes delayed union of proximal humeral fracture. We need more study about appropriate fixation using PHILOS.
    抄録全体を表示
    PDF形式でダウンロード (238K)
  • 腱板断裂関節症に人工骨頭置換と L'Episcopo 変法を行った１例
    矢野 雄一郎, 玉井 和哉, 吉川 勝久, 野原 裕
    2010 年 34 巻 3 号 p. 951-953
    発行日: 2010年
    公開日: 2010/11/16
    DOIhttps://doi.org/10.11296/katakansetsu.34.951
    ジャーナル 認証あり
    抄録を表示する抄録を非表示にする
    Reverse shoulder prosthesis is often used for irreparable rotator cuff tear with arthritis. Recently, reverse shoulder prosthesis with modified L'Episcopo procedure has been reported. We performed hemiarthroplasty together with modified L'Episcopo procedure to restore external rotation power with the arm at side in a patient who had cuff tear arthropathy. A 75-year-old female, right handed, complained of pain and weakness in the right shoulder. The pain acutely developed when she lifted the bedclothes in December, 2006. She consulted an orthopedist and underwent arthroscopic operation in February, 2007. She visited our hospital in September, 2007, because her complaints did not improve at all. On examination, the shoulder range of motion was 70 degrees in forward elevation, -20 degrees in external rotation, and right buttock in internal rotation posteriorly. She had an external rotation lag sign. Radiographs revealed osteoarthritis and magnetic resonance imaging (MRI) identified a rupture and fat degeneration of supraspinatus and infraspinatus tendons. We performed hemiarthropalsty using a bipolar prosthesis and modified L'Episcopo procedure through the deltopectoral interval in January, 2008. Postoperatively, the shoulder was immobilized in a splint in external rotation for 6 weeks; elevation and rotation exercises were encouraged thereafter. The external rotation lag sign disappeared six weeks after surgery. Six months after surgery, the shoulder range of motion was forward elevation; 80 degrees, external rotation; 30 degrees, internal rotation; L1. Hemiarthropalsty associated with modified L'Episcopo procedure can be a method to restore external rotation power with the arm at side in irreparable cuff tear with arthritis.
    抄録全体を表示
    PDF形式でダウンロード (308K)
  • 中関節上腕靭帯断裂により関節内のインピンジメント症状を呈した 2 例
    柴原 基, 菅谷 啓之, 高橋 憲正, 萩原 嘉廣, 河合 伸昭, 戸野塚 久紘, 立原 久義, 寺林 伸夫, 森石 丈二
    2010 年 34 巻 3 号 p. 955-958
    発行日: 2010年
    公開日: 2010/11/16
    DOIhttps://doi.org/10.11296/katakansetsu.34.955
    ジャーナル 認証あり
    抄録を表示する抄録を非表示にする
    We reported unusual two impingement syndrome with middle glenohumeral ligament(MGHL). (Case1) A 37 years old man was pointed out impingement syndrome by other hospital. He became conscious of instability and instability of second internal rotation. O'Brien's test, Whipple test, CAT(Combine Abduction Test), and HFT(Horizontal Flexion Test) is positive. (Case 2) A 19 years old man had left shoulder pain before 1 year. He is weight lifter, and became conscious of pain on snatch. He did not feel to be put out of joint but to be unstable. On MRI there is not Bankart lesion, and labrum injury is not unclear. In both two case, conservative treatment with rehabilitation is continued for 4 month, but symptom is not disappeared. Therefore we operated with arthroscopy. In both two case, there is not Bankart lesion, but capsular tear is recognized with impinge of MGHL into joint. We operated capsular repair and debridement. Immediately, symptom of impingement is lost and they come back sport completely for about 1 year. MGHL started on glenoid tuberculum and superior anterior labrum and touch the lesser tubercle. It is reported that MGHL is 63% on shoulder joint and thin and string MGHL is occurred anterior instability. In our study, we found hypertrophy on MGHL. We consider that MGHL is taken into joint and occurred impingement and capsular tear. On result they felt instability. It was supposed that we have one of variation for glenohumeral ligament complex.
    抄録全体を表示
    PDF形式でダウンロード (340K)
  • 肩甲下筋断裂を伴い受傷後短期間に反復性となった肩関節前方脱臼の 1 例
    川口 雅久, 根本 理, 山元 浩治
    2010 年 34 巻 3 号 p. 959-962
    発行日: 2010年
    公開日: 2010/11/16
    DOIhttps://doi.org/10.11296/katakansetsu.34.959
    ジャーナル 認証あり
    抄録を表示する抄録を非表示にする
    We report on a young adult case of short-term formed recurrent anterior shouder dislocation after trauma associated with subscaplaris muscle rupture. There was no history of an underlying pathological condition and no history of shouder subluxation or dislocation. A 26-year-old male Japan Ground Self-Defense Force soldier experienced severe pain of his left soulder in an attempt to catch ivy during ranger training on the wall, but he got a feeling of reduction shortly after self-manipulation and continued to training. Four days after the initial subluxation, he couldn't tolerate the increased pain and dislocation occurred more than 10 times. He consulted our clinic 5 days after injury. AP radiograph showed inferior displacement of the left humeral head associated with a large Hill-Sachs lesion. Plain CT showed antero-inferior bony defect of the glenoid and numerous bony fragments. In MRI, partial rupture of the subscaplaris muscle belly and detachment of the antero-inferior labrum were observed, but there was no rotator cuff injury. Because of the treatment of the cellulites and the subscaplaris muscle rupture, Latarjet operation was performed 1 month after injury. And the intraoperative findings coincided with those of the preoperative imaging. At 15-month follow up, he had no pain and his shoulder ROM returned to normal. In this case, both midsubstance rupture of the subscaplaris muscle and the continuing the ranger training may subacutely cause the recurrent, traumatic shoulder dislocation.
    抄録全体を表示
    PDF形式でダウンロード (433K)
  • 肩甲下筋腱に発生した石灰性腱炎に対し鏡視下摘出術を施行した４例
    熊本 久大, 山本 譲, 宮澤 洋, 高江洲 真, 小川 剛司, 稲垣 克記
    2010 年 34 巻 3 号 p. 963-967
    発行日: 2010年
    公開日: 2010/11/16
    DOIhttps://doi.org/10.11296/katakansetsu.34.963
    ジャーナル 認証あり
    抄録を表示する抄録を非表示にする
    Calcific tendonitis is a common disease of the rotator cuff. Conservative treatments are frequently successful. Open or arthroscopic surgery is recommended only in chronic cases, which are associated with pain and discomfort. Calcific tendonitis is seen most commonly affecting the suprasupinatus tendon. Rarely, it has been reported affecting the subscapularis tendon. We report 4 cases undergoing arthroscopic resection for calcific tendonitis in the subscapularis tendon in which conservative treatment was ineffective. All cases were checked using 3 dimensional computed tomography(3D-CT) in order to locate the calcium deposits in the cuff. The clinical results were evaluated using the Japanese Orthopaedic Association(JOA)score. All patients underwent shoulder arthroscopy in the beach chair position under general anesthesia. Arthroscopic subacromial decompression(ASD) was performed. Using a cannula as a spacer from the anterior portal, we got working space in the subcoracoid space. After location of calcific deposits using a spinal needle, a longitudinal small incision using a knife was made in the line of the subscapularis fiber. The calcification was removed using arthroscopic scissors, shaver, and electrocautery. The incised regions were repaired using suture anchors in 2 cases. The calcific deposit disappeared on postoperative radiographs in all cases. JOA score improved from preoperative 57.8(range49-69) to postoperative 86.5(range76-100) on avarage. The literature reported that calcific tendinitis involving the subscapularis tendon is associated with subcoracoid stenosis or impingement, so they described the nessesity of subcoracoid decompression. But I think the calcific tendonitis of the subscapularis tendon is also associated with subacromial impingement, because we could removed it from bursal approach. We conclude that arthroscopic removal of the calcific deposits of the subscapularis tendon has a good clinical outcome. The use of a cannula as a spacer of the subcoracoid space allowed us to remove the deposit and was also useful for repair of the rotator cuff using suture anchors.
    抄録全体を表示
    PDF形式でダウンロード (473K)
  • 化膿性胸鎖関節炎の 1 例
    南村 武彦, 千保 一幸, 森原 徹, 久保 俊一
    2010 年 34 巻 3 号 p. 969-972
    発行日: 2010年
    公開日: 2010/11/16
    DOIhttps://doi.org/10.11296/katakansetsu.34.969
    ジャーナル 認証あり
    抄録を表示する抄録を非表示にする
    Sternoclavicular joint (SCJ) infection is uncommon and accounts for 1-9% of all septic joints. Clinical recognition may be hampered by minor signs, symptoms and the tendency of SCJ pain to be referred to the shoulder. We experienced a case of septic arthritis of SCJ in which the first symptoms were shoulder pain, thus rendering an early diagnosis difficult. A 76-year-old man without predisposing risk factors presented with right shoulder pain after carrying a heavy mat suddenly. At first plain X-rays of the shoulder only were performed, but examinations of the SCJ were not performed in detail at all. After three days the patient complained of pain localized from the right SCJ to anterior chest. There was no swelling, redness or warmth, but tenderness over the right SCJ. Laboratory findings revealed the existence of an inflammation somewhere. But a first needle aspiration of the SCJ did not grow bacteria. Plain SCJ X-rays were unremarkable, but magnetic resonance imaging (MRI) and bone scintigraphy showed increased signal in the soft tissues around the SCJ. A second needle aspirate cultures grew methicillin-sensitive Staphylococcus aureus (MSSA). It took about two weeks to diagnose septic arthritis of the SCJ. He underwent drainage and antibiotic therapy. The operative findings revealed abnormal granulation in the SCJ, surrounding the joint and subclavian space. But because the inflammation did not improve, he underwent debridement again and continuous irrigation. After a year there is no recurrence. Pain due to septic arthritis of SCJ may be insidious in onset and referred to various anatomical locations, including the shoulder, neck, jaw, elbow, and can easily be confused with intrinsic shoulder or cervical spine pathologies. If the patients initially have pain referred to the shoulder, we should examine the SCJ carefully and then septic arthritis of the SCJ should be suspected.
    抄録全体を表示
    PDF形式でダウンロード (437K)
  • 意識障害後に肩肘関節強直をきたした 1 例
    橋本 瑛子, 佐藤 進一, 見目 智紀, 杉岡 香織, 落合 信靖, 国吉 一樹
    2010 年 34 巻 3 号 p. 973-976
    発行日: 2010年
    公開日: 2010/11/16
    DOIhttps://doi.org/10.11296/katakansetsu.34.973
    ジャーナル 認証あり
    抄録を表示する抄録を非表示にする
    Heterotopic ossification of the shoulder and the elbow joints simultaneously following coma is a significantly rare occurrence. A 36-year-old female, presented a stiffness of the shoulder and elbow joints after coma for a month. The range of motion of the shoulder joint was limited and all of the motion occurred at the scapulothoracic articulation. The elbow joint was ankylosis at 45 degree flexion. Radiographs and computed tomography demonstrated that heterotopic ossification was present. In the shoulder joint, a mature boney bridge between the humerus and scapula was observed. In the elbow joint, a mature boney bridge between the humerus and ulna was also observed. A bone scintigraphy revealed increased uptake in the part with the ossification. 16 months after the onset, excision of the heterotopic ossification of the shoulder and the elbow joints was performed with a one month interval between them. The ossification showed a mature bone in pathology. The patient underwent physical therapy from postoperative dayl and was given a diphosphonate to prevent a recurrence. The range of motion improved markedly after surgery and there has been no evidence of recurrence of the heterotopic ossification up until now.
    抄録全体を表示
    PDF形式でダウンロード (384K)
feedback
 Top