Katakansetsu
Online ISSN : 1881-6363
Print ISSN : 0910-4461
ISSN-L : 0910-4461
Volume 35, Issue 3
Displaying 1-50 of 78 articles from this issue
Anatomy
  • Hideya YOSHIMURA, Tomoyuki MOCHIZUKI, Keiichi AKITA, Atsuo KATO, Kumik ...
    2011 Volume 35 Issue 3 Pages 707-710
    Published: 2011
    Released on J-STAGE: December 21, 2011
    JOURNAL FREE ACCESS
    Our previous study revealed that the most proximal portion of the subscapularis tendon extended a thin tendinous slip to the fovea capitis of the humerus, and that the coracohumeral ligament (CHL) together with the SGHL was shaped like a spiral sling, supporting the long head of biceps and attached to the tendinous slip. Little information is available, however, regarding the relationship between CHL and the insertion of subscapularis on the lesser tuberosity. To clarify the significance of CHL, we examined the morphology of CHL and the subscapularis insertion in 20 cadaveric shoulders. The anterior portion of CHL arises from the base of the coracoid process and fans out laterally and inferiorly on the subscapularis. The fibers envelop the tendinous portion of the subscapularis on either side. As a result, the ligament forms a cable-like anterior leading edge over the rotator interval. The subscapularis tendon can appear in relative anatomic position unless the arm is brought into internal rotation and relaxation is achieved. We also demonstrated that CHL was associated with opening the bicipital sheath along its medial border during shoulder elevation. The coracohumeral ligament might contribute to the stability of the subscapularis tendon and to the morphology of the bicipital groove.
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  • Atsuo KATO, Kumiko YAMAGUCHI, Keiichi AKITA, Akimoto NIMURA, Tomoyuki ...
    2011 Volume 35 Issue 3 Pages 711-714
    Published: 2011
    Released on J-STAGE: December 21, 2011
    JOURNAL FREE ACCESS
    In order to understand the morphology of the rotator cuff, it is important to know the precise information of the footprints. Twelve shoulders out of six cadavers fixed by 8% formalin were used in this study. Rotator cuff muscles were removed from the scapula. The footprints of the rotator cuff tendons were exposed. The capsule was removed from the anterior end of the supraspinatus (SSP) muscle, which is the same site as the lateral margin of the intertubercular groove. The capsule was flipped posteriorly and the footprint of the articular capsule on the greater tuberosity was exposed. The widths between the footprints of the capsule and the tendons were measured at the humerus. The anterior part of the footprint of the capsule was relatively narrow. The widths of the footprints were 5.6 ± 1.6mm at the anterior side and 4.4 ± 1.2mm at the posterior side of SSP. On the other hand, at the border between the infraspinatus (ISP) and the teres minor (TM), the width of the footprint of the capsule was 9.1 ± 1.7mm. In this area, thick tendinous part of the muscles were not clealy observed. The footprint of the articular capsule beneath the SSP was narrower than that beneath the ISP. The widest point of the footprint of the capsule was located at the border between the ISP and the TM. The evaluation of the capsule would also be clinically significant as well as those of the footprints of the tendons.
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Function
  • Toru MORIHARA, Akiko OGURA, Hisakazu TACHIIRI, Toshikazu KUBO, Masao K ...
    2011 Volume 35 Issue 3 Pages 715-718
    Published: 2011
    Released on J-STAGE: December 21, 2011
    JOURNAL FREE ACCESS
    In the motion of shoulder flexion(0-90 degree), the scapula was upward rotated at the center of acromioclaviclular joint. In the abduction, the scapula was upward rotated and depressed with the clavicle elevation and retraction. The purpose of this study is to evaluate the muscle functions around the scapula by electromyographic analysis during the flexion and abduction of the shoulder. EMG activities of upper, middle, and inferior trapezius muscle, and serratus anterior, were examined in 5 static positions from 0 degrees to 150 degrees for 5 seconds in each position during exercises of shoulder flexion and abduction in 6 healthy volunteers. We used Telemyo System 2400(Noraxon USA Inc) and analyzed by MyoVideo and MyoResearch. The relative activity of upper trapezius muscle did not increase, and the muscle activity of serratus anterior was increased significantly during the early phase of flexion. The relative activity of upper, middle trapezius muscle has gradually increased during the early phase of abduction. The scapular upward rotation pattern was different between that in flexion and abduction. This study indicated that the symptom of accessory nerve palsy is disorder of abduction, and the main symptom of long thoracic nerve palsy is the inhibition of shoulder flexion.
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  • Hisakazu TACHIIRI, Toru MORIHARA, Haruhiko NAKAGAWA, Yoshikazu KIDA, T ...
    2011 Volume 35 Issue 3 Pages 719-722
    Published: 2011
    Released on J-STAGE: December 21, 2011
    JOURNAL FREE ACCESS
    Shrug exercise, which is one of the treatments for stiff shoulder and rotator cuff tear, is commonly performed. This exercise is also performed to relax the shoulder after surgery for rotator cuff repair. The effectiveness of shrug exercise for the rotator cuff has not been analyzed. The purpose of this study was to analyze the shrug exercise and to evaluate the usefulness of the shrug. Five asymptomatic male volunteers who had no history of shoulder abnormalities were examined. SSP (supraspinatus) muscle was measured by fine-wire electrodes and ISP (infraspinatus) muscle was measured by surface electrodes. At the time of non-shrug (group N) and shrug (group S), %MVC (maximal voluntary contraction) was calculated in the position of 0, 30, 60, 90 degrees flexion. %MVC of SSP in the position of 0,30,60,90 degrees flexion were 2,8,13,15% in group N, and 32,35,23,32% in group S. %MVC of SSP were increased at each angle. %MVC of ISP were 6,16,25,38% in group N, and 10,17,25,42% in group S. It has been reported that %MVC over 20% is high activity. %MVC of SSP showed over 20% at shrug position in this study, which was considered that shrug motion caused eccentric contraction of SSP muscle with the scapula elevating. From this study, it is considered that shrug excise is useful for cuff training, but may be overloaded on SSP in the early stage after surgery.
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Examination
  • Kunichika SHIN, Koumei MATSUURA, Kenjiro OOE, Toru ASAKURA
    2011 Volume 35 Issue 3 Pages 723-726
    Published: 2011
    Released on J-STAGE: December 21, 2011
    JOURNAL FREE ACCESS
    We report 3D(3Dimension) reconstruction of shoulder joint images using OsiriX (free image processing software for Macintosh). Here is how to use OsiriX. 1)download and install Osirix 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 OsiriX, and then automatically complete 3D reconstruction. OsiriX can reconstruct large data speedily, and show free cutting images. Also OsiriX has virtual endoscopy mode, and can output fly through movies which are automatically made by connecting selected images. These images help us to deepen our 3dimensional and cross - sectional understanding, and explain them to young doctors and patients. We concluded that 3D reconstruction of shoulder joint image using OsiriX on your own personal computer is very useful.
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  • Koji FUJII, Yoshitsugu TAKEDA, Katsutoshi MIYATAKE
    2011 Volume 35 Issue 3 Pages 727-729
    Published: 2011
    Released on J-STAGE: December 21, 2011
    JOURNAL FREE ACCESS
    Few studies have been conducted regarding the acromial morphology in young subjects by computed tomography(CT). The purpose of this study is to evaluate the shape of acromions in subjects of 20 years old or less by CT including multi planer reconstruction(MPR) and three dimensional(3D)images, and to refer to these results for judging the presence of acromial spurs in rotator cuff patients. Thirty-six shoulders of 23 patients of 20 years old or less with recurrent shoulder dislocations who underwent surgery were evaluated. Acromial tilt angles were significantly different among lateral, middle, and medial part(97.4°, 105.0°, and 117.9°, respectively, p<0.001). The proportion of the shapes of acromions classified into three types; flat, curved, and convex were significantly different between in 3D images and sagittal images (p<0.001). Convex architectures at the lateral edges of acromial undersurfaces were detected in 20 shoulders in 3D images. The thickness of the acromion at the lateral part was significantly thinner than that at the medial part (p<0.001). These data suggest that it is difficult to judge the acromial shape by radiography or one-dimensional images, and the convex architectures at the lateral edges of acromial undersurfaces in 3DCT images might be normal structures, so it is important to check the convex structures and the thickness of acromions in coronal images for judging the presence of spurs.
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Congenital anomaly
  • Tomonori KENMOKU, Nobuyasu OCHIAI, Hironori YAMAZAKI, Takashi SAISU
    2011 Volume 35 Issue 3 Pages 731-734
    Published: 2011
    Released on J-STAGE: December 21, 2011
    JOURNAL FREE ACCESS
    We investigated the scoliosis syndrome patient's scapula movement in lateral elevation before and after operation. Subjects were 10 patients (1 male, 9 female), and average age at the operation was 15.8 years old. The assessments were presence of Slipping of a humeral head in the arm at maximum elevation, and dynamic instability of the shoulder. We took a picture of both scapulas front images in natural standing, the 90° lateral elevation and the maximum elevation before and after operation. We measured α and β angles, and the translation rate of glenoid following what Murata et al. reported. Results showed the α angle was changed from 86.4° to 84.5° in convex, and from 80.1° to 80.7° in concave. β angel 1 was changed form 21.3° to 21.0° in convex, and 23.7° to 26.8° in concave. β angel 2 was changed form 41.1° to 36.4° in convex, 45.4° to 43.6° in concave. The translation rate of glenoid from 0 to 90° was changed from 1.24 to 1.24 in convex, and 1.29 to 1.33 in concave. The rate from 0 to maximal elevation was form 1.48 to 1.43 in convex, and from 1.57 to 1.54 in concave. Thus the convex shoulder might be more unstable than the concave shoulder.
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Dislocations
  • Youichi MURATA, Toru YOSHIOKA, Junichi HAMAWAKI, Nobukazu OKIMOTO
    2011 Volume 35 Issue 3 Pages 735-737
    Published: 2011
    Released on J-STAGE: December 21, 2011
    JOURNAL FREE ACCESS
    The purpose of this study was to compare the period of return-to-work between conservative and operative treatments for the acromioclavicular joint dislocation (Tossy grade III). A total of 40 shoulder injury cases of 40 patients participated in this study. There were 20 cases in the conservative treatment group and 20 cases in the operative treatment group. Clinical assessment was done on both groups using the JOA scores except ROM points (full marks 70 points) and the period from the injury to return-to-work using questionnaire survey by phone. The periods from the injury to the return-to-work were 3.5 weeks in the conservative treatment group and 13.8 weeks in the operative treatment group. The period was significantly shorter in the conservative treatment group than that in the operative treatment group. There was no significant difference in the JOA scores between the two groups. It has been controversial whether the acromioclavicular joint dislocation (Tossy grade III) should be treated conservatively or operatively. In this study, there was no significant difference in JOA scores except ROM points between the two groups. However, the period from the injury to the return-to-work was significantly shorter in the conservative treatment group than that in the operative treatment group. Therefore, our study suggested that the conservative treatment might be recommended for the acromioclavicular joint dislocation. The period from the injury to the return-to-work was significantly shorter in the conservative treatment group than that in the operative treatment group.
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  • Kenji HORIKIRI, Hiroshi YAMAGUCHI, Fuminori KANAYA, Naoki SUENAGA
    2011 Volume 35 Issue 3 Pages 739-742
    Published: 2011
    Released on J-STAGE: December 21, 2011
    JOURNAL FREE ACCESS
    The purpose of this study was to retrospectively analyze surgical results of acute acromioclavicular joint dislocation compairing with 5 different techniques. Sixty-seven patients were operated on using 5 techniques as follows; 1) simple K-wire transfixation of ACj ( Phemister procedure ) ; 10 patients, 2) K-wire transfixation with the coracoclavicular ( CC ) ligament repair (modified Phemister procedure) ; 9 patients, 3) K-wire transfixation with CC ligament reconstruction by the coracoacromial ligament transfer (modified Cadenat procedure) ; 12 patients, 4) simple Hook plate fixation ; 23 patients, 5) Hook plate fixation with the CC ligament repair ; 13 patients. Preoperative dislocation after Rockwood's classification were Type III ; 41 patients, Type IV ; 1 patient, and Type V ; 25 patients. The distance between the inferior margin of acromion and clavicle (AC distance) was measured on A-P view of plain X-ray before and after surgery, and at the final follow up. Results of the average AC distance before and after primary surgery, and at the final follow up were as follows ; 1) Phemister procedure : 12.2 ± 3.4mm, 1.4 ± 2.3mm, 8.9 ± 3.8mm respectively, 2) modified Phemister procedure : 13.5 ± 3.7mm, -0.4 ± 0.7mm, 4.5 ± 3.1mm, 3) modified Cadenat procedure : 15.4 ± 4.2mm, -1.1 ± 2.6mm, 5.0 ± 3.1mm, 4) simple Hook plate fixation : 13.8 ± 3.3mm, -2.5 ± 2.4mm, 0.5 ± 2.6mm, 5) Hook plate fixation with the CC ligament repair : 12.7 ± 3.7mm, -2.5 ± 2.1mm, 0.2 ± 1.3mm. From the point of upward migration at the final follow up, Hook plate fixation with or without the CC ligament repair showed significantly better results than simple K-wire fixation and K-wire fixation with the CC ligament repair or reconstruction.
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  • Kunichika SHIN, Koumei MATSUURA, Kenjiro OOE, Toru ASAKURA
    2011 Volume 35 Issue 3 Pages 743-746
    Published: 2011
    Released on J-STAGE: December 21, 2011
    JOURNAL FREE ACCESS
    We report a new method for acromioclavicular(A-C) joint dislocation using two flip buttons and fiberwire.
    We refered to MINAR(Minimally Invasive AC joint Repair) reported by Wellmann et al, and made an original drill guide using bent elevatrium. A 4.5-mm drill was used to create a pilot hole in the base of the coracoid. A fiberwire loop was threaded through the internal eyelets of a flip button. Then, the prepared flip button was pushed through the coracoid drill hole and placed under the coracoid base. One end of the flip button was then passed through a 4.5-mm drill hole placed through the clavicle in line with the base of the coracoid. Afterward, repositioning the clavicle end, the fiberwire loop was tied. Operation time was about 50 minutes. We concluded that a new method for A-C joint dislocation using two flip buttons and fiberwire is very useful.
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  • Kazuhide SUZUKI, Hiroaki TSUTSUI, Kenichi MIHARA, Daisuke MAKIUCHI, Na ...
    2011 Volume 35 Issue 3 Pages 747-750
    Published: 2011
    Released on J-STAGE: December 21, 2011
    JOURNAL FREE ACCESS
    The purpose of this study was to examine the results of open Bankart repair (OB group), arthroscopic Bankart repair using single suture technique (S group), arthroscopic Bankart repair using double suture technique (D group), and open Bankart-Bristow modified procedure (BB group), in high-demand collision and contact athletes with traumatic anterior shoulder instability. 92 collision and contact athletes (OB group:18, S group:23, D group:30, BB group:21 cases) ranging from 15 to 29 years of age (average, 20 years) were studied. The mean follow-up was 28.7 months (range 24-65 months) after surgery. The rate of return to preoperative sports activities and the rate of recurrence after surgery were evaluated. The clinical outcome measures included the JSS Shoulder Instability Score (JSS-SIS) and Rowe score. All of the cases (100%) returned to their preoperative sports from 3 to 12 months after surgery (average OB group:7.6, S group:5.9, D group:6.3, BB group:4.5 months). Sixteen cases (4 cases of OB group, 6 cases of S group, 6 cases of D group, no cases of BB group) experienced re-dislocation. At the time of the last investigation, the average JSS-SIS and Rowe score were 83.7 and 80.4 in OB group, 81.4 and 71.3 in S group, 91.6 and 85.7 in D group, and 97.4 and 97.6 in BB group respectively. In this study, the best selection for operation for high-demand collision and contact athletes with traumatic anterior shoulder instability was open Bankart-Bristow procedure because it had early return to collision and contact sports, and no recurrence.
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  • Daisuke MAKIUCHI, Kazuhide SUZUKI, Naoya NISHINAKA, Taishi UEHARA, Sug ...
    2011 Volume 35 Issue 3 Pages 751-753
    Published: 2011
    Released on J-STAGE: December 21, 2011
    JOURNAL FREE ACCESS
    The purpose of this study was to evaluate the clinical results of arthroscopic Bankart repair for traumatic anterior shoulder instability and to compare the outcome in patients who have Bankart lesions versus those with anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesions. This study included 86 patients (86 shoulders), 70 male and 16 female, who underwent arthroscopic Bankart repair for traumatic anterior shoulder instability, by use of suture anchors, and they were observed for more than 2 years postoperatively. In 64 shoulders a Bankart lesion was repaired and in 22 shoulders an ALPSA lesion was repaired. The average age at the time of surgery was 24.2 years old in the Bankart lesion group (Classic Bankart group) and 26.8 years old in the ALPSA lesion group (ALPSA group). The average follow-up was 27.7 months in the Classic Bankart group and 25.5 months in the ALPSA group. JSS shoulder instability score (JSS-SIS), Rowe score, and recurrence rate were evaluated. JSS-SIS and Rowe score were 87.8 and 83.8 in the Classic Bankart group, and 86.5 and 81.8 in the ALPSA group respectively at the time of final investigation. 8 cases in the Classic Bankart group and 2 cases in the ALPSA group had experienced re-dislocation. In the several factors, there was no statistical difference among the groups. This study suggested that the clinical results of arthroscopic Bankart repair for traumatic anterior shoulder instability were not related to the type of Bankart lesion.
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  • Wataru SAHARA, Shinichi YAMADA, Minoru YONEDA
    2011 Volume 35 Issue 3 Pages 755-758
    Published: 2011
    Released on J-STAGE: December 21, 2011
    JOURNAL FREE ACCESS
    Our concept is tensioning of IGHL/LC rather than reduction of a bony fragment in arthroscopic bony Bankart repair. The purpose of this study was to evaluate the condition of IGHL/LC and to investigate the factors affecting this condition. Twenty-seven patients, 28 shoulders, with recurrent anterior instability treated by arthroscopic bony Bankart repair were enrolled. We measured the position of the humeral head center by ABER MRI and evaluated the attachment site, inclination and thickness of IGHL/LC by point rating. Then, the bone loss of glenoid, the size of bony fragment and its displacement were measured from 3D-CT images. The humeral head center was located 8 +/- 8% posteriorly relative to the glenoid center in ABER MRI. The inclination of IGHL/LC was correlated with the position of the humeral head center, and the higher inclination of IGHL/LC showed that the humeral head center was located more posteriorly. But the inclination of IGHL/LC was not correlated with the size of the bony fragment or bone loss of the glenoid.
    The tensioning of IGHL/LC was necessary for the control of the humeral head center posteriorly. Its tensioning may not only be influenced by the bone loss of the glenoid and the size of fragment but also by the condition of IGHL/LC.
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  • Isshin MATSUMOTO, Yoichi ITO, Tomoya MANAKA, Naoto OEBISU, Kenji MAMOT ...
    2011 Volume 35 Issue 3 Pages 759-763
    Published: 2011
    Released on J-STAGE: December 21, 2011
    JOURNAL FREE ACCESS
    The purpose of this study was to evaluate a minimum of one-year clinical results and clinical features of arthroscopic Bankart repair in middle aged patients over 50 years old. We retrospectively evaluated 22 shoulders (22 middle aged patients, 9 male and 13 female) of arthroscopically treated Bankart lesions with a minimum of one-year follow up. The average age at the time of surgery was 63.1 years old(range, 50-82). Clinical features such as previous histories of shoulder dislocations, morphological evaluation of Bankart lesion, accompanied rotator cuff tears and additional surgeries were evaluated. Clinical results were evaluated using a Rowe score. Range of motions of external rotation at 90° of abduction at supine position was measured and compared to those of healthy shoulders.Previous shoulder dislocations below the age of 30 years old were in 23%; Bankart lesions were in 91% and capsular rupture were in 9%; accompanied rotator cuff tears were in 55%; additional rotator cuff repair surgeries were performed in 6 patients. Recurrence of shoulder dislocation in these cases was not observed. The averaged Rowe score was 45.5 points in stability, 15.9 points in motion, 22.0 points in function and 83.4 points in total. Averaged acquired range of motion of external rotation was 89.3° for surgically treated shoulders and 99.5° for healthy shoulders; the ratio between these was 90%. Arthroscopic Bankart repair surgeries in middle aged patients over 50 years old have shown good clinical outcomes at a minimum of one-year follow up.
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  • Makoto SAKURAI, Yozo SHIBATA, Tsuyoshi SHINODA, Teruaki IZAKI, Takeshi ...
    2011 Volume 35 Issue 3 Pages 765-769
    Published: 2011
    Released on J-STAGE: December 21, 2011
    JOURNAL FREE ACCESS
    Arthroscopic Bankart repair was performed on athletes who had shoulder instability, in order to for them to return to the athletic field. For this purpose, athletic rehabilitation was developed. This program consists of 4 stages. The first stage (0-8 weeks) is the most protective period for the shoulder, the second period (9-16 w) is a mild protective period, the third stage(17-24 w) is a slight protective period, the forth stage (after 24 w) is the return to sports.
    The subjects in this study were 74 athletes (76 shoulders) who had shoulder instability and had arthroscopic Bankart repair. There were 67 males and 7 females, the average age was 22 years old. There sport events were baseball(20), basketball(9), rugby(6), karate(7), judo(6), volleyball(6), skiing(5), soccer(3), surfing(2) and others(10).
    13 shoulders (17%) were re-dislocated. The average JOA score was 73.1 points pre-operatively and 93.8 points post-operatively. The average JSS instability score was 48.2 points and 90.9 points, JSS sports score was 44.8 points and 87.9 points, pre-and post-operatively respectively. Re-dislocation rate was 62.5% in those who returned to sports activity within 4 months after the operation and was 9% in those who did so at greater than 6 months after operation. The athletes who could wait to return to sports activity longer than 6 months after the surgery, could decrease their impairment to some degree according to this program.
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  • Kota KOIZUMI, Kenji HAYASHIDA, Makoto TANAKA
    2011 Volume 35 Issue 3 Pages 771-773
    Published: 2011
    Released on J-STAGE: December 21, 2011
    JOURNAL FREE ACCESS
    We evaluated the anterior shoulder translation at 90° abduction in the scapular plane at various angles of external and internal rotation to elucidate which rotation position shows anterior instability in patients with recurrent anterior shoulder dislocation. Thirty-two shoulders of 31 patients with recurrent anterior dislocation were enrolled in this study. All had Bankart lesion and underwent operative treatment (arthroscopic Bankart repair or open Bankart & Bristow procedure). Under general anesthesia at supine position, the examiner kept the shoulder at 90° abduction in scapular plane, drew the humeral head anterior, and assessed the translation of humeral head to the glenoid from maximum external rotation to maximum internal rotation of every 10° interval. Eight shoulders showed the translation of humeral head over the rim of the glenoid and never reduced spontaneously (grade 3), 20 shoulders showed over the rim but reduced spontaneously (grade 2), and 4 shoulders showed run on the rim (grade 1). Twenty-eight shoulders (grade 3 and 2) were defined as a dislocation group and we investigated the range of rotation, in which humeral head showed over grade 2 translation. Almost all showed translation over grade 2 in the middle range of rotation but not in maximum external and internal rotation. The mean range in which the shoulders showed translation over grade 2 was from 5° internal rotation to 56° external rotation and the center of the range was 25° external rotation. The shoulders of grade 3 translation tended to show a broader range of translation over grade 2. In the shoulders with recurrent anterior dislocation, translation over grade 2 was seen in the middle range of rotation so establishment of stability in the middle range of rotation could be important to prevent recurrence after surgical treatment.
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  • Yoshitsugu TAKEDA, Koji FUJII
    2011 Volume 35 Issue 3 Pages 775-778
    Published: 2011
    Released on J-STAGE: December 21, 2011
    JOURNAL FREE ACCESS
    Our aim was to test the validity of arthroscopic method with reference to the bare spot for quantifying glenoid bone loss in patients with shoulder instability. 3D-CT scans of both shoulders were obtained from 19 patients with anterior instability (13 males, 6 females: mean age 23.9 years old) and 27 patients without instability (18 males, 9 females: mean age 59.2 years old) prior to arthroscopy. For the patients without instability, the glenoid width was measured on CT images in both shoulders, and the distances from bare spot to anterior and posterior glenoid rim were measured arthroscopically according to Burkhart. For the patients with instability, the rate of glenoid bone loss was calculated with CT and arthroscopic measurement. Among the patients without instability, two patients showed more than 5% difference of glenoid width measured on 3D-CT between the two shoulders, and were excluded in this study. In the 25 patients with normal glenoid, we could not identify the bare spot in 3 shoulders. The bare spot was identified at the center in only 8 shoulders, and it was found more than 2mm anterior from the center in 4 shoulders. Among 19 patients with instability, we could not identify the bare spot in 2 shoulders. Pearson's correlation coefficient showed significant (p<0.001) correlation (r=0.84). However, more than 5% difference of glenoid bone loss rate between 3D-CT and arhtorsocpy was found in 6 shoulders. The results showed that bare spot is not consistently located at the center of the inferior glenoid, and the arthroscopic measurement of the glenoid bone loss using the bare spot as a landmark may not be accurate for some patients. Bare spot method combined with preoperative 3D-CT evaluation would be preferable for evaluating the glenoid bone defect precisely.
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  • Nariyuki MURA, Daisaku TSURUTA, Isao TAKEI, Akemi SUZUKI, Toshihiko OG ...
    2011 Volume 35 Issue 3 Pages 779-781
    Published: 2011
    Released on J-STAGE: December 21, 2011
    JOURNAL FREE ACCESS
    The purpose of this study was to evaluate the postoperative outcome and complications of arthroscopic Bankart repair using Bioknotless suture anchors for traumatic anterior shoulder instability. From June 2005 to January 2008, 33 consecutive patients underwent arthroscopic Bankart repairs with Bioknotless suture anchors in Yamagata University Hospital and Tohoku Central Hospital. Two patients were lost in following up. 29 patients 31 shoulders were evaluated and data was available. There were 24 male and 7 female shoulders. The mean age of the patients at the time of surgery was 25 years old (range, 15 to 55 years old ). Results at a minimum of 24 months follow-up evaluation (range, 24 to 59 months) were reported. The mean JSS instability score significantly increased from 57 to 92 points. The mean loss of external rotation with arm at the side was 3.8° and that at 90° of abduction was 5.2°. Postoperative recurrent anterior dislocation occurred in 2 patients (6%) who were Judo and Ski athletes in college. Mild osteoarthrosis was shown on postoperative radiographs in two patients and progressed in one patient. There was an enlargement of 10 bone holes for anchors in 8 patients. Deep infectious sign was not detected in any case. The breakage of inserter rod was found out in one patient. In conclusion, Arthroscopic Bankart repair with Bioknotless suture anchors might be one of the good options for traumatic anterior shoulder instability. However, Another procedure may be considered for the contact or collision athletes.
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  • Hitoshi SHITARA, Atsushi YAMAMOTO, Tsutomu KOBAYASHI, Kenji TAKAGISHI, ...
    2011 Volume 35 Issue 3 Pages 783-786
    Published: 2011
    Released on J-STAGE: December 21, 2011
    JOURNAL FREE ACCESS
    The aim of this study was to evaluate short-term follow-up of arthroscopic Bankart repair (ABR) for traumatic anterior shoulder instability, with special emphasis on the bone defect of glenoid and clinical outcome. 25 shoulders that had ABR performed using suture anchor technique and that were able to observe for more than a year postoperatively were investigated. We evaluated them using the Japanese Orthopaedic Association (JOA) score, Constant score, Rowe score, recurrent rate of shoulder dislocation, percentage of the glenoid rim defect (Itoi et. al.), glenoid rim morphology and postoperative shoulder ROM limitation. Statistical analyses were performed concerning the clinical outcomes (pre vs. post-ope and over 21% vs. under 21% defect of glenoid rim) with paired t test and unpaired t test, respectively. Statistical significance was calculated based on a 5% level. The average JOA, Constant and Rowe score improved significantly. There was no significant limitation of postoperative shoulder ROM and recurrence of shoulder dislocation. Glenoid rim morphology: Normal, Erosion, Fragment = 0, 16, 9 shoulders respectively. Percentage of the glenoid rim defect: over 21%, under 21% = 7, 18 shoulders respectively. All patients in the over 21% group were complicated by bone fragment. There was no significant difference in ROM, power, scores between the over 21% and under 21% group. In this study, there was no significant difference between the over 21% group and the under 21% group in the clinical outcomes of the comparison of pre-op with post-op. In the over 21% group, the patients had the complication of separation fracture, so, it was different from pure glenoid defects like erosion defect type (including compression fracture) reported by Itoi and others. Arthoscopic Bankart repair may be applied to a patient with over 21% glenoid defect, only if complicated by separation fracture.
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  • Akemi SUZUKI, Nariyuki MURA, Daisaku TSURUTA, Toshihiko OGINO
    2011 Volume 35 Issue 3 Pages 787-789
    Published: 2011
    Released on J-STAGE: December 21, 2011
    JOURNAL FREE ACCESS
    The purpose of this study is to clarify the relationship between glenohumeral joint morphology and characteristic features of traumatic anterior shoulder instability. We examined 30 shoulders of 30 patients who had computed tomography before their operations. There were 24 males and 6 females. The mean age was 24 years old. Twenty-three were dislocations and 7 were subluxations. The mechanism of injury was classified into two groups, traumatic group (fall or direct injury) and minor injury group (overhead activity). The traumatic group consisted of 16 shoulders and the minor injury group consisted of 14 shoulders. We measured the maximum transverse diameters of the articular surface of the glenoid and the maximum diameters of the humeral head in uninjured shoulder and calculated the glenoid-head ratio. We also examined glenoid rim morphology by three-dimensional CT in the injured shoulderr. Glenoid rim morphology was classified into three groups, bony Bankart lesion, morphologic abnormality and normal. We investigated the relationship between glenoid-head ratio and gender, dislocation or subluxation and the mechanism of injury. We also investigated the relationship between the mechanism of injury and glenoid rim morphology. The mean of the glenoid-head ratio was 65.3%. There was no difference in gender, dislocation or subluxation and the mechanism of injury. But glenoid-head ratio tended to be smaller in females and the minor injury group. In glenoid rim morphology, sixteen males had bony Bankart lesion and four females had normal glenoid rim morphology. Also seventy-five percent of the traumatic group had bony Bankart lesion and fifty percent of minor injury had normal glenoid rim morphology. Bony Bankart lesions were much seen in males and the traumatic group, and morphologic abnormality or normal glenoid rim were much seen in females and the minor traumatic group.
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  • Ryo MURATA, Shigehito KURODA, Noriyuki ISHIGE, Syuhei OGINO, Motohiko ...
    2011 Volume 35 Issue 3 Pages 791-793
    Published: 2011
    Released on J-STAGE: December 21, 2011
    JOURNAL FREE ACCESS
    The scapula rotates upwardly during shoulder elevation. Given that the center of the rotation was the humeral head, not on the scapula, the movement of the glenoid would be regarded as the rotation along the humeral head. We have reported this concept of “functional glenoid” at the previous annual meeting of Japan Shoulder Society. The purpose of this study was to provide more accurate findings regarding this concept. Patients with habitual shoulder dislocation (unstable group; n=12) and normal control (n=12) were included in the study. 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 lines was measured (α angle). The difference of the glenoid inclination angles between IR1 and Zero position (β angle) were then measured, and the glenoid extension ratio (α+β/α) was calculated and statistically analyzed with t-test. β angle was significantly lower in the unstable group than in the control group (p=0.023). The glenoid extension ratio was smaller in the unstable group than in the control group but did not show a significant difference (p=0.078). Interobserver reliability was analyzed with inter-class correlation coefficient and showed good correlation for α angle (r=0.805) and β angle (r=0.711), respectively. Intraobserver reliability was also analyzed with the same method and showed good correlation for α angle (r=0.842) and β angle (r=0.823), respectively. These results may suggest that reduction of “functional glenoid” is associated with dynamic instability of the glenohumeral joint in habitual shoulder dislocation. The methodology we employed was useful in terms of inter/intraobserver reliability.
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Fractures
  • Isoya GOYA, Hiroshi YAMAGUCHI, Fuminori KANAYA, Naoki SUENAGA
    2011 Volume 35 Issue 3 Pages 795-798
    Published: 2011
    Released on J-STAGE: December 21, 2011
    JOURNAL FREE ACCESS
    In recent years, proximal humerus fractures have become one of the major fractures in orthopedics trauma. The purpose of this study was to investigate the Shoulder function of post operative(PO) proximal humerus fracture. 19 shoulders treated with intramedullary nail were prepared for this study. They were divided into 3 groups, which were defined as follows; Group1) 50-64 year-old, Group2) 65-74 year-old Group3) 75- year-old. Post operative and unaffected range of motion of the shoulder (flexion (Flex), external rotation (ER), and internal rotation (IR)) were investigated once a month until 6 months. Results of range of motion of the shoulder were as follows; Group 1 (PO; F147, ER52.5, IR4.7/ unaffected side; F163, ER56.7, IR6.0), Group 2 (PO; F133, ER54, IR3.6/ unaffected side; F149, ER54.2, IR4.6), Group3(PO; F120, ER48, IR4.0/ unaffected side ; F126, ER50.8, IR3.7). 75 years old or more people recovered to pre-operative function. However, 50-64 year-old people had limitations of range of motion, in particular flexion and internal rotation.
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  • Yuji HATAKEYAMA, Moto KOBAYASHI
    2011 Volume 35 Issue 3 Pages 799-802
    Published: 2011
    Released on J-STAGE: December 21, 2011
    JOURNAL FREE ACCESS
    The purpose of this study was to evaluate the operative outcome of valgus-impacted proximal humeral fracture. Sixteen patients who underwent open reduction and plate fixation between October 2002 and June 2009 were evaluated. There were 2 males and 14 females. The mean age was 66 years old (39-83) and the average follow-up period was 33 months (11-71). All patients had valgus-impacted 3-part fracture. The average humeral head (HH) inclination angle was 167°(150-197) (unaffected side 145°). The average medial Calcar length was 8.9 mm(0-15) and the lateral displacement of humeral head was 1.3 mm (0-4). The postoperative mean active flexion/abduction: 150°(110-180)/148°(110-180), ER/IR: 50°(25-70)/T11 (L5/S1-T6). The average JOA score was 95 points (83-100). The average HH inclination angle was 143°(130-151) at operative day, 140°(120-150) at final follow up. There was no evidence of humeral head necrosis. Good short term outcome was achieved functionally and radiologically with no signs of correction loss or avascular necrosis of humeral head.
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  • Naoaki KAWAKAMI, Takahiko HIROOKA, Yasuro OZE, Hiroyuki HASHIZUME, Mit ...
    2011 Volume 35 Issue 3 Pages 803-806
    Published: 2011
    Released on J-STAGE: December 21, 2011
    JOURNAL FREE ACCESS
    We treated 17 elderly patients with proximal humeral fractures who were more than 70 years old using intramedullary nail, including 4 males and 13 females with an average age of 84 years old (ranging from 71 to 96 years old). According to AO classification, there were 8 cases of A2, 2 cases of A3, 4 cases of B1, and 3 cases of B2. The surgery in all cases was performed under general anaesthesia. The reduction was checked fluoroscopically. Post-operatively the arm was supported in a sling. Pendular movements were started from the first post-operative day. The functional and radiological outcomes were reviewed. 17 patients were assessed with regard to pain and shoulder flexion. Callus formation and cortical continuity was observed on radiographs for evidence of radiological union. In our study all the fractures united clinically and radiologically except in two patients. There was one case of nonunion. An open reduction and internal fixation with bone graft was undertaken five months after intramedullary nail fixation. Cut out of the nail from the humeral head was found in one case and a hemiarthroplasty was undertaken three weeks after intramedullary nail fixation. We stressed the importance of anatomical reduction of the fracture and correct surgical technique. Depending on the fracture type, it is important that the greater tuberosity with the rotator cuff tendons is sutured to the nail with nonabsorbable thread.
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  • Ritsuro OZAKI, Raita NAGASAWA
    2011 Volume 35 Issue 3 Pages 807-811
    Published: 2011
    Released on J-STAGE: December 21, 2011
    JOURNAL FREE ACCESS
    Os acromiale is non-union of one or more ossification centers of the acromion. We will report on seven cases of os acromiale treated operatively during the period between March 2009 and January 2010. The average age was 53 years old (15 to 74). Six shoulders were pointed out incidentally. (Five shoulders were diagnosed with rotator cuff tear (RCT) and one was diagnosed with recurrent dislocation of the shoulder (RDS). The remaining one shoulder was diagnosed on careful examination of shoulder pain. At the operation, instability of the os acromiale was confirmed arthroscopically in all shoulders. Next, they had open reduction and internal fixation with a tension-band procedure. Of those shoulders, sliding method was used in three shoulders and an artificial bonegraft was used in one. Four shoulders had an excision of the non-union site. RCT was treated by arthroscopic rotator cuff repair and RDS was treated by arthroscopic Bankart repair at the same time. We studied the location of unfused area, the rate of bone union and the results of the surgery using JOA score. The unfused area was located in the os meso- acromiale in all shoulders. Six of those shoulders had osseous union, and one shoulder had a non-union due to a distruption of the fixation. Six shoulders that got bone union showed improvement in the JOA score from 63 to 94. When the deltoid muscle contracts, the os acromiale is pulled downward. In this study, two shoulders with osseous continuous in undersurface of the acromion got instability later, as if a chocolate bar cracked. We named this mechanism “Chocolate bar phenomenon”.Inferior displacement of os acromiale onto rotator cuff causes subacrominal impingement, pain and rotator cuff tear. It is necessary to treat every case of os acromiale with fixation.
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  • Satoshi INOUE, Shinichi KURIYAMA
    2011 Volume 35 Issue 3 Pages 813-816
    Published: 2011
    Released on J-STAGE: December 21, 2011
    JOURNAL FREE ACCESS
    There are some implants for distal end fracture of the clavicle. The purpose of this study was to compare the clinical outcome between Scorpion Plate which doesn't cross AC joint and Wolter Plate which does cross AC joint. We evaluated 7 patients who were treated by Scorpion Plate(group S)and 9 patients who were treated by Wolter plate(group W)at Japanese Red Cross Society Wakayama Medical Center from 2003 to 2007. The mean duration of abduction limit was 6 weeks in group S, 20 weeks in group W. The mean duration patients were able to achieve abduction at 90° was 2.1 weeks in group S, 4.8 weeks in group W, at 180° was 6.3 weeks in group S, 27.3 weeks in group W. The mean ROM at 1, 3, 6 months was 116° 155° 165° in group S, 76° 88° 164° in group W respectively. The mean duration until removal of the implant was 30 weeks in group S, 20 weeks in group W. ROM improved earlier in group S than in group W because Scorpion plate doesn't cross AC joint and releases the abduction limit early. In group S surgeons could wait to remove the implant until complete bone union. However ROM at 6 months was the same in both groups.
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Disorders of the muscle and tendon
  • Yukihiko HATA, Norio ISHIGAKI, Koichi NAKAMURA, Toshiro ITSUBO, Narumi ...
    2011 Volume 35 Issue 3 Pages 817-819
    Published: 2011
    Released on J-STAGE: December 21, 2011
    JOURNAL FREE ACCESS
    This study was undertaken to evaluate the effectiveness of this operative procedure by analyzing follow-up data for 10 or more years after surgery. Of the patients followed for 10 years or longer after mini open repair, 41 shoulders (follow-up rate, 85.4%) were enrolled in this study, excluding patients who died, developed paralysis of the cervical spinal cord, or required reoperation. The mean age at the time of surgery was 58.2 years. There were 23 males and 18 females. This study had 4 small tears, 22 moderate-sized tears, 12 large tears, and 3 massive tears. The mean postoperative follow-up period was 10.8 years. Clinical evaluations using JOA and UCLA scores, measurements of the range of motion (ROM) and muscular strength, and diagnostic imaging (MRI and plain X-ray) were carried out, and the significance of differences between pre- and postoperative findings and data was tested statistically. Both JOA and UCLA scores improved significantly after surgery (p<0.0001). In ROM, improvement was seen only in the range of flexion (p<0.05), while the range of abduction, external rotation during dropping, and external rotation during abduction decreased after surgery (p<0.05,p<0.001,p<0.01, respectively).Muscular strength improved significantly only in the direction of external rotation (p<0.05). When signal density within the tendon at the supraspinous muscle/tendon attachment site was evaluated by MRI, it had become uniformly low in 27 shoulders (66%). When evaluated by plain X-ray, 7 shoulders showed progression of arthrotic changes. In cases having undergone mini open repair, favorable shoulder joint function was preserved even at 10 years or more after surgery, accompanied by favorable repair of the rotator cuff, and arthritic changes were mild. These long-term results suggest that mini open repair is a promising means of treating rotator cuff tears.
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  • Toru MORIHARA, Hisakazu TACHIIRI, Akiko OGURA, Yoshikazu KIDA, Haruhik ...
    2011 Volume 35 Issue 3 Pages 821-824
    Published: 2011
    Released on J-STAGE: December 21, 2011
    JOURNAL FREE ACCESS
    Several methods for massive rotator cuff tear have been developed. In our university, the cases of moderate cuff tear underwent McLaughlin procedure, and the cases of massive rotator cuff tear underwent Debeyre-Patte procedure. In this study, the clinical results in both groups were evaluated by JOA score. We examined 38 shoulders of 38 patients(28 male and 10 female, the average age was 59 years old)who underwent rotator cuff repair from in 1996 to 2000. The mean follow-up period was 13.4 years. JOA scores including pain, muscle power, ADL activity and ROM were investigated in the final observation period. In the group of McLaughin procedure, the scores in the pain, muscle power, ADL activity and ROM were 27.6, 8.9, 9.0, 28.0 points respectively. In the group of Debeyre-Patte procedure, the scores were 23.8, 7.6, 8.0, and 24.0 points respectively. Significant statistical difference between them was only found the scores in ROM. The clinical results in both groups were good in the long term follow-up period.
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  • Isao SHIRACHI, Kensei NAGATA, Masafumi GOTOH, Yasuhiro MITSUI, Fujio H ...
    2011 Volume 35 Issue 3 Pages 825-827
    Published: 2011
    Released on J-STAGE: December 21, 2011
    JOURNAL FREE ACCESS
    In clinical settings, intra-articular injections of hyaluroni acid (HA) and steroid are frequently used in conservative treatments in patients with rotator cuff tear. This study was undertaken to examine the effects of HA and steroid on cell toxicity in tendon fibroblasts from patients with rotator cuff tear. Seven patients with full-thickness rotator cuff tear were subjects for this study, with the average age of 56 years. Specimens of the supraspinatus tendon were obtained during arthroscopic surgery. The specimens were cut and cultivated in DMEM, and second and third passage cells were used. The tendon fibroblasts were cultured in the presence of HA (Artz®,1.0mg/ml) or various concentrations of steroid (Rinderon®, 2.5-10mg/ml) for 24 hrs. After stimulation, the cell toxicity was examined using Live-Dead Cell Staining Kit®(Bio Vision), and observed by confocal laser scanning microscopy. As control, the cells were cultured exclusively with 1% DMEM. There appeared to be none/minimal cell toxic effects in HA, while the considerably stronger effects were found in steroid with the dose-dependent manner. Both HA and steroid have anti-inflammatory effects, and are utilized for the treatment of rotator cuff tears. Our data demonstrated that cell toxicity was none/extremely-minimal in the HA-treated fibroblasts, but enormous in the steroid-treated fibroblasts; however the toxic effects were decreased dose-dependently. On the basis of these findings, use of HA/low-concentration steroid may be more favorable for cases in which the intra-articular use of anti-inflammatory agents is needed.
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  • Issei NAGURA, Takeshi KOKUBU, Hanako NISHIMOTO, Ryosuke SAKATA, Atsuyu ...
    2011 Volume 35 Issue 3 Pages 829-832
    Published: 2011
    Released on J-STAGE: December 21, 2011
    JOURNAL FREE ACCESS
    Cartilage plays an important role in the restructure of tendon to bone interfaces after rotator cuff repair. In this study, we targeted the cells derived from human rotator cuff and investigated whether they have the potential for chondrogenic differentiation. The edges of the rotator cuff were harvested from patients who had sustained a rotator cuff tear and underwent arthroscopic rotator cuff repair. The harvested rotator cuff was minced, and the cells were cultured in monolayer culture. Flow cytometric analyses were performed using monoclonal antibodies. To induce chondrogenesis, a pellet culture was performed for three-dimensional culture for 3 weeks. About 2.5x105 cells were spun in serum free ITS-medium containing dexamethasone, ascorbate, proline, recombinant BMP-6 and TGF-β3. Chondrogenic differentiation was determined by gene expression using RT-PCR technique, histological and immunohistochemical analyses. Flow cytometric analyses showed positive immunoreactivities for CD29, 44, 105, 166. The other tested markers were negative. After 3 weeks the cells showed a chondrogenic differentiation as evidenced by expression of type II and X collagen in the RT-PCR analyses and the immunohistochemistry. These results showed that the cells derived from human rotator cuff have the potential for chondrogenic differentiation like the bone marrow stem cells. It is suggested that human rotator cuff derived cells have the possibility of participation in the restructure of tendon to bone interfaces.
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  • Tadanao FUNAKOSHI, Norimasa IWASAKI, Akio MINAMI, Naoki SUENAGA, Naomi ...
    2011 Volume 35 Issue 3 Pages 833-835
    Published: 2011
    Released on J-STAGE: December 21, 2011
    JOURNAL FREE ACCESS
    Visualization of the vascularity after rotator cuff repair would be useful for improving treatments for rotator cuff tear. The purpose of this study was to assess vascularity inside a tendon or an adjacent rotator cuff insertion point after rotator cuff repair. Nine patients (5 men, 4 women) consented to participate in the study. Contrast agent for enhanced ultrasound was injected intravenously. Enhanced ultrasound images of the torn cuff and the contralateral shoulder were recorded for 1 minute preoperatively. Four small regions of interest, inside the tendon, the bursa, and anchor hole were studied on all shoulders. The same procedures were carried out at 1, 2, and 3 months after the surgery. There was a significant increase in blood flow in the intratendinous region at 1 month after the surgery. Blood flow decreased after 2 month. We found obvious blood flow in the anchor hole at 3 months after the surgery. Vascularity in Bursal tissue had the same pattern as that inside the tendon. The findings of this investigation were that the postoperative hypervascular pattern in intratendinous tissue was comparative with the preoperative pattern. These blood flows may be associated with the healing process of tendon-to-bone insertion.
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  • Tomonobu HAGIO, Yozo SHIBATA, Tsuyoshi SHINODA, Teruaki IZAKI
    2011 Volume 35 Issue 3 Pages 837-840
    Published: 2011
    Released on J-STAGE: December 21, 2011
    JOURNAL FREE ACCESS
    Proprioception was studied in rotator cuff tear and normal shoulder using active angle reproduction test. Subjects and methods: In cuff tear group(RCT), 33 cases (33 shoulders) were studied. They were 19 males and 14 females, their average age was 66.4 years.The average active elevation angle was 112.4° and the average external rotation angle was 51.4°. As a control group (C), 20 cases (20 shoulders) who had not had previous injury or disease in their shoulder were studied. Average elevation angle was 160.3° and average external rotation angle was 61.9°. The subjects were studied sitting on a chair and had a bandage put over their eyes. They rotate or elevate their shoulder to any angle. The difference absolute values between average of 3 times of reproduction of the angle and the target angle were studied. The target angles were 30° of internal rotation, 30° and 45° external rotation, 30°, 45° and 60° of elevation. In 30° of IR, error angle revealed 7.0° in RCT and 2.6° in C group (P<0.01). These were 4.6° and 2.5°(P<0.01) in 30° of ER, 3.6° and 2.5°(P=0.15) in 45° of ER. These were 4.0° and 2.1° in 30° of elevation (P<0.05), 4.1° and 1.9° in 45° of elevation (P<0.01), 4.8° and 2.4° in 60° of elevation(P<0.01). Proprioception of rotator cuff tear was lower than that of normal shoulder.
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  • Keisuke MATSUKI, Nobuyasu OCHIAI, Tomonori KENMOKU
    2011 Volume 35 Issue 3 Pages 841-844
    Published: 2011
    Released on J-STAGE: December 21, 2011
    JOURNAL FREE ACCESS
    Many articles have reported that fatty infiltration of rotator cuff muscles was one of the important factors to affect the outcomes of rotator cuff repairs and did not improve even after successful rotator cuff repairs. However, these studies were based on qualitative evaluation of fatty infiltration such as Goutallier's staging. We reported that T2 mapping technique of MRI had potential to evaluate fatty infiltration quantitatively. The purpose of this study was to assess the changes in fatty infiltration of rotator cuff muscles after arthroscopic rotator cuff repairs (ARCR) using T2 mapping. Twelve shoulders from 12 patients were enrolled in this study. Subjects consisted of 7 males and 5 females with a mean age of 61 years old (range, 44-76). There were 2 partial, 4 small, 1 medium, 3 large and 2 massive tears. They underwent MRI at 3, 6 and 12 months after ARCR. T2 mapping was performed at Y-shaped view and the average T2 of the supraspinatus (SSP) and infraspinatus (ISP) muscles were measured. The cross-sectional areas of SSP and ISP were also measured. One-way repeated-measure ANOVA was used for statistical analysis and the level of significance was set at p<0.05. Re-tears were found in 1 large and 2 massive tears. Average T2 of SSP at 3, 6 and 12 months were 43.8 ± 7.2, 40.4 ± 4.7 and 38.6 ± 3.7 msec, respectively, and the change was significant (p=0.01). Average T2 of ISP were 39.1 ± 5.9, 37.4 ± 5.9 and 36.6 ± 2.9 msec, respectively (p=0.24). There were no significant changes in the cross-sectional areas of SSP and ISP. T2 of SSP significantly decreased in the successful repairs (p=0.04); however, there were no significant changes in the shoulders with re-tears. The results of this study indicated that fatty infiltration of rotator cuff muscles could be reversed after successful repairs.
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  • Naomi OIZUMI, Naoki SUENAGA
    2011 Volume 35 Issue 3 Pages 845-848
    Published: 2011
    Released on J-STAGE: December 21, 2011
    JOURNAL FREE ACCESS
    It is controversial as to whether postoperative functional recovery is better with arthroscopic rotator cuff repair (ARCR) than open rotator cuff repair (ORCR). The purpose of this study is to compare postoperative recovery of evaluation score, muscle power and ROM between the 2 procedures. Eleven shoulders after ORCR (7 men and 4 women, average age: 66.8 years old, 3 large tear and 8 medium tear) and 16 shoulders after ARCR (10 men and 6 women, average age: 59.8 years old, 2 large tear and 14 medium tear) were included in this study. Successful repair of the tendon was confirmed by MRI in all cases. JOA score at 6 and 12 months after surgery, muscle strength (flexion, abduction, and external rotation) at 6 months, and postoperative recovery of ROM (flexion, abduction, external rotation, and internal rotation) until 12 months were investigated. Statistical analysis was performed with the use of Mann-Whitney's U test (P<0.05; significant). The average JOA score (6 months / 12 months) was 90.5 / 93.5 points in ORCR and 91.2 /94.6 points in ARCR. There were no significant differences between ORCR and ARCR. Muscle strength at 6 months was better in ARCR. Active flexion and passive internal rotation at 90° abduction position at 12months were significantly better in ARCR. Postoperative JOA score and pain were improved comparably in both groups, however, muscle strength and ROM recovered better in ARCR. Less invasive procedure to the deltoid muscle is considered to be the reason for better functional recovery of ARCR.
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  • Hirokazu NAGAI, Shinji IMAI, Ryo NAKAJIMA, Mitsuhiko KUBO, Yoshitaka M ...
    2011 Volume 35 Issue 3 Pages 849-852
    Published: 2011
    Released on J-STAGE: December 21, 2011
    JOURNAL FREE ACCESS
    From 2007, we performed arthroscopic rotator cuff repair with suture bridge technique. The purpose of this study was to evaluate clinical and structural outcomes of this technique. The patients with rotator cuff tears, who were treated by suture bridge technique under arthroscopy, were followed for more than 6 months, and assessed for the clinical results by JOA score and repair condition by MRI. Fifty four shoulders of 51 patients (15 female and 37 male) were included in the present study. The average age at surgery was 63.3 years old, and the mean follow up period was 16.7 months. The size of tear preoperatively was 7 partial tear, 5 small tear, 22 midium tear, 12 large tear, 8 massive tear. The repair condition with MRI was classified by Sugaya's classification. JOA score improved from the average of 68.3 points (42 ∼ 92 points) preoperatively to 92.2 points (67 ∼ 100 points) postoperatively. MRI findings revealed 24.1% incidence rate of recurrent rotator cuff tears, and it was 50.0% for large and massive tears. Re-tear was recognized around medial row anchors in 30.8% in the present study. Suture bridge technique for shoulders with large and massive tear was considered to be able to improve clinical outcomes, but may not be able to keep repair integrity.
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  • Kenji HAYASHIDA, Makoto TANAKA, Kota KOIZUMI
    2011 Volume 35 Issue 3 Pages 853-856
    Published: 2011
    Released on J-STAGE: December 21, 2011
    JOURNAL FREE ACCESS
    The clinical result of arthroscopic triple row suture anchor repair (combined operation of double anchor footprint fixation and single row method) for complete rotator cuff tear is reported in the present study. Twenty-two shoulders (the average age at operation was 69 years old: range 53-78) were involved and followed for more than 6 months (average follow up: 10 months). The clinical results were evaluated with JOA shoulder score and post operative cuff integrity was assessed by MRI and classified with Sugaya's classification. The pre-operative average JOA score, which was 71.5, improved to 92.1 at follow up. Regarding post operative cuff integrity, complete repair (type 1 and 2) was seen in 13 shoulders (59%), repaired with thin tendon (type 3) was seen in 2 shoulders (9%), re-tear (type 4 and 5) was seen in 7 shoulders (32%). In re-tear cases, 6 of 7 were type 4, and type 5 was seen in only 1 case. Comparing this to our previous data of repair integrity of double row suture anchor method, type 4 increased and type 5 decreased. Cutting out tendon by tight bridging sutures could be the cause of increasing type 4, and tension adjustment of bridging sutures could be important to prevent tendon cut out.
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  • Takahiko HIROOKA, Yasuro OZE, Naoaki KAWAKAMI, Hiroyuki HASHIZUME, Mit ...
    2011 Volume 35 Issue 3 Pages 857-859
    Published: 2011
    Released on J-STAGE: December 21, 2011
    JOURNAL FREE ACCESS
    We examined patients with re-tear of the rotator cuff after arthroscopic repair performed at our hospital by MRI and evaluated its causes.The subjects were 105 shoulders. The size of the complete tears was small in 27 cases, medium in 59 cases, and large in 19 cases. The repair methods were the dual row technique (DR), suture bridge (SB), and DAFF. The supraspinatus and infraspinatus were evaluated by MRI taken more than 6 months after surgery. Type 4 or 5, according Sugaya's classification, were defined as re-tear, and re-tear rate, the age at the surgery, its relationships with re-tear site, preoperative tear size, and suture method were evaluated. Re-tear was observed in 12 shoulders and was type 4 in 11 and type 5 in 1. The mean age at surgery was 74.6 years old in those who suffered re-tear and 67.8 years old in those showing complete repair, with a significant difference. The site of re-tear was the medial suture site in 6 cases, lead-in area from the stump in 5 cases, and side-to-side suture site in 1 case. Re-tear was observed in 5 cases with medium tears, and 7 cases with large tears. Re-tear was observed in 4 cases treated with DR, 8 cases treated using SB. No re-tear was noted in the shoulders after DAFF. The concentration of medial stress is considered to be the main factor in re-tear on the medial side. To prevent re-tear, it is considered important to select a repair technique that does not allow the concentration of stress at the medial suture site for small and medium tears, and to select methods such as the patch method for large tears.
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  • Eiichi ISHITANI
    2011 Volume 35 Issue 3 Pages 861-864
    Published: 2011
    Released on J-STAGE: December 21, 2011
    JOURNAL FREE ACCESS
    We had 110 cases that we performed arthroscopic rotator cuff repair (ARCR) on and followed up for 6 months. The massive tears occurred in 18 cases. The evaluation of MRI at six months postoperative used Sugaya classification. In the MRI classification, the re-tear group belonging to Type IV, V were 11/110 cases (10.9%). In the massive tears, the re-tear group was 8/18 cases (44.4%). We were unsatisfied with the re-tear rate of the massive tears, so we investigated the relation of some operative factors and the re-tear of massive tears. The examined factors were the number of anchors, the methods of operation, the size of the tear and age. We found no significant differences between the no-tear group belonging to TypeI, II, III and the re-tear group in the size of tear and age, but found significant differences in the number of anchors. The average of the no-tear group was 4.8 and the re-tear group was 3.8. The main methods we used were single row (SR), double row (DR), bridging suture (BS) and margin convergence (MC). In the no-tear group, SR had 0 cases, DR had 8 cases, BS had 2 cases, and MC had 2 cases. In the re-tear group, SR had 2 cases, DR had 3 cases, BS had 3 cases, and MC had 4 cases. In cases that had SR and combined MC and SR re-tear occurred. We showed that the risk of re-tear was increased when we could not insert enough anchors. The desirable number of anchors was more than 5. We have to select the method of patch and graft, if we can not insert enough anchors and can not do DR and BS.
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  • Kanichi SHIMOKAWA, Hitoshi ITO
    2011 Volume 35 Issue 3 Pages 865-868
    Published: 2011
    Released on J-STAGE: December 21, 2011
    JOURNAL FREE ACCESS
    We presented the clinical and structural outcome of arthroscopic rotator cuff repair with alternative repair methods for patients who had full-thickness tear in posterosuperior rotator cuff. Eighty-nine consecutive patients who had had full-thickness posterosuperior rotator cuff tears grouped to two of the followings. In the BS group (44 cases 44 shoulders, 28 men and 15 women, whose average age was 67.3 years old), the torn cuff was repaired using suture anchors by bridging method. The AT Group consisted of 45 cases (21 men and 24 women, whose average age was 66.7 years old) received arthroscopic transosseous repair through medial and lateral intersecting bone tunnels. There were no differences between the groups about regarding age, size of tear, and preoperative duration of symptoms. Clinical outcome was evaluated using Japanese Orthopaedic Association shoulder score (JOA-SS), range-of-motion, and muscle strength. Structural outcome was evaluated using MRI-imaging classification after Sugaya.
    All patients in both groups improved after surgery on pain, range-of-motion, JOA-SS and muscle strength. Clinical results were not significantly different in the two groups. Postoperative repair integrity also showed no difference in either group. The arthroscopic transosseous rotator cuff repair was equally as effective as suture anchor bridging repair for full-thickness posterosuperior rotator cuff tears.
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  • Daisuke MORI, Fumiharu YAMASHITA, Takanori NAGAOKA, Noboru FUNAKOSHI
    2011 Volume 35 Issue 3 Pages 869-872
    Published: 2011
    Released on J-STAGE: December 21, 2011
    JOURNAL FREE ACCESS
    This study investigated the early clinical outcomes and cuff integrity of triple row fixation after arthroscopic repair of large rotator cuff tears with delamination. We evaluated 12 shoulders in 12 patients (10 males and 2 females, average age: 59.1 years old). The average follow-up period was 19.5 months (range: 13-26 months). The triple-row surgical technique was performed using a third row of fixation placed between the typical medial and lateral rows. One year postoperatively, the clinical outcomes and cuff integrity were assessed by JOA score and Sugaya's MRI classification, respectively. Muscle strength was measured with MicroFET preoperatively and one year after surgery. The average JOA score improved from 58.5 to 93.5 points. On MRI study, type 1 repair was seen in 7 shoulders, Type 2 repair in 4 shoulders, and Type 5 in 1 shoulder. The re-tear rate was 8.3 percent. The average JOA score in the re-tear group was 76.5 points. The average shoulder abduction strength improved from 34.3 to 86.1 N at 45°of abduction (P<0.0001), and from 31.8 to 81.5 N at 90° of abduction (P<0.0001). External rotation strength improved from 29.1 to 78.8N (P<0.0001). Internal rotation improved from 60.5 to 88.1 N (P<0.0001). The arthroscopic triple row suture anchor method for large rotator cuff tears with delamination yielded excellent outcomes. This procedure is an effective option for selected patients demonstrating large rotator cuff tears with delamination.
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  • Keiko HORIGOME
    2011 Volume 35 Issue 3 Pages 873-876
    Published: 2011
    Released on J-STAGE: December 21, 2011
    JOURNAL FREE ACCESS
    We evaluated the efficacy of our arthroscopic cuff repairing (ARCR) procedure for partial-thickness articular side rotator cuff tear (APRCT). Our procedure comprises arthroscopic subacromial decompression, debridement of the articular side torn cuff, conversion of the partial tear to a full-thickness tear, and fixation of the tear to the humeral head using a single-row anchoring technique. From December 2004 to January 2009, 15 patients with APRCT were treated with this procedure and followed up for more than 12 months. There were 10 male and 5 female patients with the average age of 53.1 years old. The average postoperative follow-up period was 28.2 months. Evaluation included Japanese Orthopaedic Association score (JOA score) at final follow-up, the Constant score, strength of shoulder abduction and external rotation at postoperative 12 months, complications, and evaluation of unsatisfactory results.
    The JOA score improved from 71.8 to 88.2 on average at final follow-up. The Constant score improved from 51.2 to 69.1. The average strength of shoulder abduction and external rotation increased from 3.9kg to 5.1kg and from 6.0kg to 7.7kg, respectively. There were no complications. Four patients had JOA score of under 80 and were unsatisfactory. Preoperative contracture of the shoulder was seen in 2 patients, re-tear of the repaired cuff in 1 and capsulitis in 1. These results support the therapeutic value of our ARCR procedure with conversion from a partial- to full-thickness tear. Simultaneous capsular release for contracted shoulders and an alternative double-row anchoring technique may further improve the clinical outcomes.
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  • Hisahiro TONOTSUKA, Hiroyuki SUGAYA, Norimasa TAKAHASHI, Nobuaki KAWAI ...
    2011 Volume 35 Issue 3 Pages 877-881
    Published: 2011
    Released on J-STAGE: December 21, 2011
    JOURNAL FREE ACCESS
    The purpose of this study is to determine a target ROM (T-ROM) at 3 months after arthroscopic rotator cuff repair, by which patients can expect eventual full recovery. Subjects consist of 209 shoulders in 202 patients, including 116 males and 86 females with an average age of 61.5 years old, who underwent primary arthroscopic rotator cuff repair and were followed-up for a minimum of 2 years. There were 30 partial-thickness tears, 120 small to medium and 57 large to massive full-thickness tears. Anterior elevation (AE), external rotation at side (ER), and internal rotation (IR) ROM at 3 month after surgery (ROM-3M) were measured, and divided into five groups according to the values. The final ROM at 24 months after surgery was compared with each ROM-3M of these subgroups in order to determine the T-ROM. Then, according to the T-ROM, patients were also divided into two groups: less than the T-ROM (AE-, ER-, and IR-); and more than the T-ROM (AE+, ER+, and IR+), and average ROM in each group were compared with each other.
    The final ROM of AE was significantly better in the group of more than 120° than less than 120 degrees. Therefore, the T-ROM of AE was determined as 120°. Similarly, those of ER and IR were determined as 10° and L5 level. ROM at 6 and 9 months in the AE+ group was significantly better than those of the AE- group. Further, every ROM at 3 to 24 months in the ER+ group was significantly better than those of the ER- group. In conclusion, ROM at 3 months after surgery affects final shoulder function. Surgeons and therapists should pay attention to the T-ROM at 3 months after surgery described above in order to maximize patients's final shoulder function.
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  • Toshiaki HIROSE, Shinsuke NONAKA, Shigekazu UENO, Shigeharu KIMURA, Sh ...
    2011 Volume 35 Issue 3 Pages 883-887
    Published: 2011
    Released on J-STAGE: December 21, 2011
    JOURNAL FREE ACCESS
    We performed arthroscopic rotator cuff repair (ARCR) for all rotator cuff tears. The purpose of this study was to evaluate the clinical results of ARCR using double-row technique. We retrospectively studied 64 patients (65 shoulders) who had received ARCR using double-row technique and who were followed up for more than 2 years. The patients were 30 males and 35 females. The mean age at operation was 65 years old (range, 44-86). The mean postoperative follow-up period was 25 months (range, 24-36). The clinical results were assessed using JOA scores and MRI by Sugaya's classification. Tear size was small tear in 9 shoulders, medium in 36, large in 12, and massive in 8. The mean JOA total score was significantly improved from 66 points preoperatively to 96 points postoperatively. Postoperative MRIs showed 20% re-torn cuff in all cases, especially, 40% in large and massive tears. In 45 shoulders which had MRI taken regularly, re-tear by MRI was revealed within 3weeks: none, at 3 months: 4 shoulders, at 6 months: 1shoulder, at 1 year: 4 shoulders, and 2 years: none. In this study, the clinical results of ARCR using double-row technique was mostly satisfactory. But JOA score in no tear group (97points) was better than re-tear group (92points). So we have to consider the methods to prevent re-tear after ARCR.
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  • Takashi KIBA, Toru MORIHARA, Hisakazu TACHIIRI, Kentaro SASAKI, Yoshio ...
    2011 Volume 35 Issue 3 Pages 889-892
    Published: 2011
    Released on J-STAGE: December 21, 2011
    JOURNAL FREE ACCESS
    Our previous report suggested that our scoring system, CRPS score, may be useful for the evaluation of the degree and clinical course of symptoms or signs like CRPS.
    The purpose of this study is to examine the clinical outcome of symptoms or signs like CRPS after arthroscopic rotator cuff repair and the relation between CRPS score and JOA score. We examined 13 patients (men, 10; women, 3; mean age, 64 years old) who exhibited symptoms like CRPS after surgery. The mean follow-up period was 13 months.We determined whether the patients exhibited sensory disturbance, abnormal color, swelling, stiffness, or sweat disturbance and scored 1 point for each sign. CRPS score was calculated as the sum of these points. We examined the CRPS score at 3 weeks and 6 months after ARCR and the JOA score before ARCR and at 6 months after ARCR. The patients could be classified into 3 groups depending on this score at 3 weeks after surgery: group A(2 points; 5 cases), group B(3 points; 4 cases), and group C(4 points; 4 cases). The CRPS scores of all groups improved, and the clinical outcome in group A was better significantly than that in groups B and C. The JOA scores of all groups improved too, but there were no significant differences among the 3 groups.
    In this study, similar to previous reports, no relation was observed between symptoms or signs like CRPS and JOA score after rotator cuff repair.
    The clinical outcome of symptoms or signs like CRPS could be evaluated by using CRPS score. The patients with CRPS score of ≤ 2 points at 3 weeks after ARCR showed a better outcome than those with a score of ≥ 3 points. The results revealed that if the CRPS score was low, clinical outcome would be getting better.
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  • Makoto TANAKA, Kota KOIZUMI, Kenji HAYASHIDA
    2011 Volume 35 Issue 3 Pages 893-895
    Published: 2011
    Released on J-STAGE: December 21, 2011
    JOURNAL FREE ACCESS
    High strength sutures are widely used in arthroscopic rotator cuff repairs (ARCR), as the initial fixation strength is a significant concern. There was a report about the erosive change of the acromion after ARCR, due to physical impingements by strong sutures or chemical effects. There is no clinical consensus about the erosion, even though it seems to be one of the causes of secondary pain after ARCR. In this study, we reviewed the incidence of the subacromial erosion after double row ARCR, and analyzed the correlation with the clinical findings. 56 cases of rotator cuff(RC) tear, which underwent double-row ARCR with high strength sutures, were included in this study. We evaluated the subacromial erosion and the retear of RC with MRI, pain at 3 months and the range of motion at 6 weeks, 3 months and 6 months and JOA scores at 1 year after operations.
    25 cases (44.6%) showed the subacromial erosion. The subacromial erosion was classified into two different types. ‘Dent type’ was recognized as a small depression of the acromion. ‘Wide type’ showed the subacromial erosion in the broad range. The retear rate was higher in the group without the subacromial erosion (51.6%) than in that with the subacromial erosion (16.0%). There was a significant difference in JOA pain score at 3 months after operation, which were 21 and 16.9 on average in patients with erosion (E+) and without erosion (E-), respectively. In ROM, there was a relative difference in the flexion at 6 weeks, which was 135.4° in group E+ and 118.4° in grou p E-. There were no differences in the other durations and the range of external rotation. The patients with less pain and more forward flexion without retear tended to show the erosive changes of the undersurface of the acromion.
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  • Takahiko HIROOKA, Yasuro OZE, Naoaki KAWAKAMI, Hiroyuki HASHIZUME, Mit ...
    2011 Volume 35 Issue 3 Pages 897-901
    Published: 2011
    Released on J-STAGE: December 21, 2011
    JOURNAL FREE ACCESS
    We performed arthroscopic surgery on 14 middle-aged to elderly patients in whom MRI did not reveal any tear of the rotator cuff, but arthrography showed the instant bulging of the contrast medium in the lateral area of the coracoid process, suggesting a rotator interval lesion. We investigated the intraoperative arthroscopic findings and postoperative results, with a postoperative follow-up of 6 months or more. The subjects consisted of 7 males and 7 females. Ages at the time of surgery ranged from 56.0 to 79.0 years old. In all patients, scapulohumeral arthroscopy revealed incomplete tear of the supraspinatus on the articular side and enlargement of the rotator interval. Tear of the subscapular is was observed in 9 shoulders. Tendon injury of the biceps long head was noted in 5 shoulders. Incomplete tear of the supraspinatus was repaired with trans-tendon repair. In 8 shoulders with tear of the subscapularis, interrupted suture with an anchor was selected for repair. In 1, debridement alone was performed. The mean range of shoulder motion for flexion, abduction, and external rotation before surgery was 155.0°, 152.9 °, and 46.4°, respectively. On the final survey, it was 158.6°, 156.4°, and 32.9°, respectively. The mean preoperative JOA scores for pain and total evaluation were 10.0 and 72.8 points, respectively. On the final survey, the scores were 26.8 and 91.1 points, respectively. Based on MRI findings on the final survey, 13 shoulders were classified as type 1 according to Sugaya's classification, and 1 as type 2. In middle-aged to elderly patients, tear of the supraspinous muscle tendon on the articular capsule side and tear in the superior region of the subscapular muscle tendon led to enlargement of the rotator interval. The short-term results of repair of the supraspinous and subscapular muscle tendons were favorable.
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Degenrative diseases
  • Nobuaki KAWAI, Hiroyuki SUGAYA, Norimasa TAKAHASHI, Hisahiro TONOTSUKA ...
    2011 Volume 35 Issue 3 Pages 903-906
    Published: 2011
    Released on J-STAGE: December 21, 2011
    JOURNAL FREE ACCESS
    Primary frozen shoulder is believed to be a self-limited disease. However, many patients complain of prolonged symptoms such as night pain and refractory stiffness. The purpose of this study is to estimate the efficacy of steroid injection to the glenohumeral joint for primary stiff shoulder associated with night pain. Subjects consisted of 115 consecutive patients, including 37 males and 72 females with an average age of 59.4 years old, who were diagnosed as having primary frozen shoulder at the shoulder clinic in our institute from May to November, 2009. Our treatment principles are as follows: we recommend patients who complain of night pain to keep their arm at rest and carry out trunk and scapular exercises, in addition to steroid injection to the glenohumeral joint once a week until the night pain subsides. Then, physiotherapy is initiated of the hand of therapists. Range of motion at the first visit and at the time when the night pain disappeared was evaluated, as well as that at the final follow-up which was 5.8 months on average.The mean forward flexion, external and internal rotation significantly improved when the night pain disappeared, which was 4.8 weeks on average, from 97.5, 9.2°, and S level to 117.5, 17.4°, and L4 level. The range of motion at the final follow-up was 144 degrees in flexion, 31 in external rotation, and L2 level in internal rotation.Steroid injection to the glenohumeral joint was effective for pain relief for patients with primary frozen shoulder associated with night pain. Removing inflammation at the glenohumeral joint is a key factor when treating such patients and this also enables patients to proceed with effective physiotherapy.
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  • Akiyoshi HANDA, Yoshiyasu UCHIYAMA, Hiroyuki HASHIMOTO, Joji MOCHIDA, ...
    2011 Volume 35 Issue 3 Pages 907-910
    Published: 2011
    Released on J-STAGE: December 21, 2011
    JOURNAL FREE ACCESS
    Many studies have reported treatment effects of H2 receptor antagonists (H2RA) on calcific tendinitis (CT) of the shoulder. The purpose of this retrospective study is to compare the clinical outcome between the cimetidine and the famotidine of CT of the shoulder. We studied 72 patients with CT of the shoulder who were closed with H2RA (cimetidine or famotidine) and loxoprofen sodium from 2005. They were treated as follows, 41 with cimetidine and loxoprofen (group C) (14 males, 27 females, average age 54.3 years old) 17 with famotidine and loxoprofen (group F) (10 males, 7 females, average age 58.4 years old) and 14 with loxoprofen(group N) (8 males, 6 females, average age 60.2 years old). Shoulder joint pain was assessed by using visual analogue scale (VAS), and the site and size of calcium deposits were calculated by X-rays (frontal view and scapula Y). In addition, influences of the complicating diseases (diabetes mellitus and hypertension) were evaluated for treatment effects. Groups C and F improved their pain and decreased calcium deposit size more than group N (p<0.05). However, the pain and calcium deposit size was not significantly different between group C and group F. Diabetic patients reduced the effectiveness more than non-diabetic patients in groups C and F. Hypertensive patients reduced the reduction ratio of calcium deposit more than non- hypertensive patients in groups C and F. There were the same clinical results for both cimetidine and famotidine for the CT of the shoulder. Diabetes mellitus and hypertension inhibited the treatment effects of H2RA.
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  • Tomoya MATSUHASHI, Norimasa IWASAKI, Naoki SUENAGA, Naomi OIZUMI
    2011 Volume 35 Issue 3 Pages 911-914
    Published: 2011
    Released on J-STAGE: December 21, 2011
    JOURNAL FREE ACCESS
    Osteoarthritis (OA), which is a progressive degenerative joint disease, is one of the most common forms of arthritis. Therefore, OA poses a significant public health problem. However, the etiology of OA still remains poorly understood. Glycobiology, defined as the analysis of the biological function of sugar chains covalently bound to proteins and lipids, has been recently applied to molecular-based investigations. Several studies have shown that glycan modifications of proteins contribute to the pathogenesis of some diseases. In this study, we attend to the relationship between human articular cartilage N-glycans and cartilage degradation such as cuff tear arthropathy. In this study, we first showed alterations in the N-glycan pattern of human articular cartilage between a normal group and a cuff tear arthropathy group. By comparing the N-glycan pattern obtained from these groups, we showed that the composition of human articular cartilage N-glycans significantly changed with cuff tear arthropathy. In addition, these N-glycans were localized on the chondrocyte surfaces and in the cytoplasm. The N-glycan modifies almost all protein after translation. Several reports showed that intercellular reactions, the receptor workings, and the quality control of glycoprotein are controlled by changing the composition of N-glycans. The N-glycans identified in this study are expected to attach to the glycoproteins and the receptors on the chondrocyte surface, and to contribute heavily to the degradation of articular cartilage. Future studies are required to determine the biological roles of the N-glycans identified here in OA pathogenesis.
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  • Shogo MUKAI, Yasuaki NAKAGAWA, Yoshihisa TANAKA
    2011 Volume 35 Issue 3 Pages 915-918
    Published: 2011
    Released on J-STAGE: December 21, 2011
    JOURNAL FREE ACCESS
    The osteoarthritis of glenohumeral joint is relatively rare and the pathomechanism is not well understood. Using MRI, we analyzed the incidence and the location of the cartilage injury which are not detected by plain x-rays and try to elucidate the relationship between rotator cuff tear and osteoarthritis. The materials were patients who came to our clinic with various shoulder problems and were examined by MRI during 2009, which included 98 patients (67 men and 31 women), 100shoulders. The mean age was 61.9 years (37-90). MRI and plain x-rays were reviewed in all cases. OA changes were assessed by obvious osteophyte, cartilage defect, narrowing of the width of the cartilage and the abnormal signal of subchondral bone. Decentering of humeral head is defined by the relationship of the humeral head and the glenoid. The diagnosis were 39 rotator cuff tears which included 30 complete-tear and 9 incomplete/small-tear, and 61 non-tears. The decentering of humeral head was found in 16 of 39 complete-tear shoulders, 10 of which were displaced superior and 6 were inferior. Six of 61 non-tear shoulders showed decentering, all of them displaced inferiorly. OA changes were seen in superior portion of 18 humeral head, inferior portion of 48 heads, and 41 glenoids. The pattern of locations of these findings was significantly different between complete-tear and non-tear shoulders. OA changes of upper portion were significantly more often found in complete-tear shoulders. Cartilage lesions indicating osteoarthritic findings are found in the inferior portion of the humeral head more than in the superior portion of the head and the glenoid. The pattern of combination of the position of the decentering humeral head and the location of the OA changes is significantly different between complete-tear and non-tear shoulders, but it is similar with incomplete/small-tear and non-tear shoulders.
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