肩関節
Online ISSN : 1881-6363
Print ISSN : 0910-4461
ISSN-L : 0910-4461
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36 巻, 3 号
選択された号の論文の85件中51～85を表示しています
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筋腱疾患
  • ノットレスアンカーを使用した腱板修復術の治療成績と knot impingement の発生頻度
    永澤 雷太, 尾崎 律郎
    2012 年 36 巻 3 号 p. 995-998
    発行日: 2012年
    公開日: 2012/10/25
    DOIhttps://doi.org/10.11296/katakansetsu.36.995
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    Background: We reported about knot impingement after arthroscopic rotator cuff repair. The cause of knot impingement is thought to be the knots of the suture anchor. Considering the reddish synovitis in bursa and crater-like acromial erosion, the cause of knot impingement may be not only mechanical impingement but also some kind of chemical factors. The purpose of this study is to investigate the correlation between using knotless anchor and knot impingement.
    Methods: We treated 109 rotator cuff tear patients operated on using knotless anchor. The morphology of the acromion was evaluated by 3DCT. Clinical results were evaluated according to JOA score.
    Results: There was no severe type of knot impingement in any patients. The mild type was existed in 4%. The incidence of knot impingement decreased.
    Conclusion: We supposed that using knotless anchor is to prevent from knot impingement.
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  • 上腕二頭筋長頭筋腱欠損が広範囲腱板断裂例の肩関節機能低下および回復に及ぼす影響
    市川 耕一, 伊藤 陽一, 松本 一伸, 間中 智哉, 中村 信之, 中村 博亮
    2012 年 36 巻 3 号 p. 999-1002
    発行日: 2012年
    公開日: 2012/10/25
    DOIhttps://doi.org/10.11296/katakansetsu.36.999
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    Background: Long head of the biceps brachii (LHB) tendon has an important role in maintaining shoulder function. LHB tendon ruptures sometimes occur in the cases of rotator cuff tears. Severe shoulder dysfunction was recognized in massive rotator cuff tears, though the influence of LHB tendon deficiencies in such cases is not well known. The aim of this study was to determine the influence of LHB tendon deficiencies on shoulder dysfunction or recovery in shoulders with massive rotator cuff tears.
    Methods: We evaluated 85 shoulders that had undergone arthroscopic rotator cuff repair surgeries for massive rotator cuff tears. We evaluated LHB tendon during arthroscopy; 26 shoulders were classified into the group of LHB deficiencies (group minus) and 59 shoulders were classified into the group of intact LHB(group plus). We assessed each surgical procedure as a complete repair or an partial repair. Clinical outcomes were evaluated by the JOA shoulder scoring system, active ROM preoperatively and postoperatively. Each parameter was statistically analyzed between the two groups.
    Results: The average preoperative JOA scores and active ROM were not different between two groups. Complete repair was performed in 15/26(58%) cases in group minus and in 50/56(89%) cases in group plus. Postoperative clinical results were significantly lower in group minus than those in group plus when partial repair was included.
    Conclusion: LHB tendon deficiencies do not have an influence on preoperative shoulder dysfunction in shoulders with massive rotator cuff tears. However, LHB tendon deficiencies make complete rotator cuff repair more difficult than intact LHB tendon does. Postoperative clinical results were not different between two groups when excluded partial repair.
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変性疾患
  • 特発性肩関節拘縮に対するステロイド内服療法の効果
    中溝 寛之
    2012 年 36 巻 3 号 p. 1003-1005
    発行日: 2012年
    公開日: 2012/10/25
    DOIhttps://doi.org/10.11296/katakansetsu.36.1003
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    Background: This study was conducted to verify the effectiveness of oral steroidal medication for the patients of frozen shoulder with frequent nocturnal pain.
    Methods: Twenty-seven patients (9 males and 18 females) who had frozen shoulder with frequent nocturnal pain participated in this study. All patients did not have diabetes mellitus and rotator cuff tear. Their mean age was 55.4 years old and mean duration of symptoms was 4.3 months. They were treated with oral steroidal medication for 6 weeks. They were given 10mg/day of Prednisolone for first 3 weeks, and 5mg/day for next 3 weeks. Range of motion (ROM) of the shoulder, visual analogue scale (VAS) and JOA pain score were investigated after 6 and 12 weeks.
    Results: The VAS decreased from 78.1 mm to 18.8 mm at 12 weeks after the treatment. The JOA pain score was improved from 4.4 to 21.1 points. ROM of the shoulder was improved in all cases. Nocturnal pain disappeared in 24 patients (88.9%). A gastric discomfort was found in 2 cases, however no gastric ulcer was found with gastrointestinal endoscopy.
    Conclusion: Oral steroidal medication was considered to be effective for patients of frozen shoulder. However sufficient care is needed to reveal the side effects.
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  • 一次性変形性肩関節症における肩甲骨関節窩の形態調査
    山口 浩, 金谷 文則, 末永 直樹, 福嶺 紀明
    2012 年 36 巻 3 号 p. 1007-1009
    発行日: 2012年
    公開日: 2012/10/25
    DOIhttps://doi.org/10.11296/katakansetsu.36.1007
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    Background: There was no morphologic study, which investigated in the primary glenohumeral osteoarthritis (GHOA) in Japanese. The purpose of this study is to investigate whether there are any characteristic changes of the primary GHOA with CT scans.
    Methods: CT scans were obtained of 57 shoulders with primary osteoarthritis of the glenohumeral joint. The measurement was performed at the middle level of the glenoid. Glenoid morphology was assessed qualitatively by measurement of the glenoid retroversion using the technique reported by Friedman et al (1). Morphologic changes of the glenoid were evaluated by Walch's classification (2) as follows; Type A was characterized by a well-centered humeral head and a balanced distribution of strengths against the surface of the glenoid. The erosion may be minor-type A1 or major-type A2. In Type B, the posterior subluxation of the humeral head was responsible for the asymmetric load against the glenoid, particularly the exaggerated posterior wear pattern: B1 showed narrowing of the posterior joint space, subchondral sclerosis, and osteophytes, and type B2 demonstrated a posterior cupula that gave an unusual biconcave aspect of the glenoid. Type C was defined by a glenoid retroversion of more than 25 degree.
    Results: Mean Glenoid retroversion was 5.7°. Morphology was classified as follows; 61% classified in type A, of them A1 in 49% and A2 in 12%. 37% in type B, of them B1 in 23% and B2 in 14%. 2% in type C.
    Conclusion: There are some difference between Japanese and Westerns in morphologic change of the primary glenohumeral osteoarthritis.
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  • 肩鎖関節変形性関節症に対する鏡視下鎖骨遠位端切除術の中期臨床成績
    間中 智哉, 伊藤 陽一, 松本 一伸, 市川 耕一, 中村 信之, 中村 博亮
    2012 年 36 巻 3 号 p. 1011-1014
    発行日: 2012年
    公開日: 2012/10/25
    DOIhttps://doi.org/10.11296/katakansetsu.36.1011
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    Background: The purpose of this study was to evaluate medium term clinical results of arthroscopic distal clavicle resection for the treatment of painful acromioclavicular (AC) joint osteoarthritis.
    Methods: We evaluated 101 shoulders of 91 patients, who had undergone arthroscopic distal clavicle resection with a minimum 12 months follow up. Average age at the time of surgery was 59.1 years old and average duration of the follow up was 40.6 months. Histories of traumatic episode were observed in 3 cases of type I and II AC joint injury and in 8 cases of other major traumatic events. Clinical evaluation was composed of 4 different items: other pathological lesions except AC lesion, arthroscopic surgical procedure, tenderness of the AC joint and horizontal adduction test.
    Results: Impingement syndrome was accompanied in all the cases. Thirty-eight cases of SLAP lesion, 52 cases of rotator cuff tears, 17 cases of LHB tear and 30 cases of shoulder joint stiffness were observed. ASD and arthroscopic distal clavicle resection was performed on 101 shoulders, ARCR on 28 shoulders and capsulotomy on 30 shoulders. Complete disappearance of AC joint tenderness was recognized in 94 shoulders; mild AC joint tenderness remained in 7 shoulders at final follow up. There was no pain in horizontal adduction test in all cases at final follow up as well as at 3 months follow up.
    Conclusion: Our results showed arthroscopic distal clavicle resection is an effective surgical procedure at medium term follow up for the treatment of painful AC joint osteoarthritis.
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その他
  • 投球障害肩における肩甲骨関節窩の軌跡：機能的関節窩について
    村田 亮, 黒田 重史, 石毛 徳之, 荻野 修平, 三笠 元彦
    2012 年 36 巻 3 号 p. 1015-1018
    発行日: 2012年
    公開日: 2012/10/25
    DOIhttps://doi.org/10.11296/katakansetsu.36.1015
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    Background: The scapula rotates upwardly during shoulder elevation. If the rotation center wasn't fixed on the scapula but on the humeral head, the movement of the glenoid would be regarded as the rotation along the humeral head. We have analyzed throwing shoulder injury cases using this concept of “functional glenoid”.
    Methods: Patients with throwing shoulder injury (TSI group; n=22) and normal control (n=8) 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 the superior and inferior tubercle to the center of the humeral head in IR1 image, and the angle of the lines was measured (α angle). The TSI group was divided to two groups according to slipping of the humeral head in zero position images. 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. Each set of data was statistically evaluated.
    Results: In the TSI group, β angle and the glenoid extension ratio did not show significant difference compared to the control group, but the slipping-negative cases showed significantly larger β angle than slipping-positive cases and the control group.
    Discussion: These results may be derived from multifactorial pathology of throwing shoulder injury. Significantly large β angle in slipping-negative TSI cases may indicate an adaptive pattern of movement of the scapula. The glenoid extension ratio could not reflect the scapular kinematic change of throwing shoulder injury.
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  • 投球フォームによる投球動作の運動学的相違
    大井 雄紀, 二宮 裕樹, 駒井 正彦, 信原 克哉
    2012 年 36 巻 3 号 p. 1019-1022
    発行日: 2012年
    公開日: 2012/10/25
    DOIhttps://doi.org/10.11296/katakansetsu.36.1019
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    Background: Throwing form is classified into four groups in general, but not much is mentioned about the differences in their throwing motion. The aim of this study was to describe and compare the kinematic differences of four throwing forms.
    Methods: Two hundred and forty pitchers' throwing was measured by motion capture system. Then a rigid-body model was defined and employed in order to compute the kinematic parameters that were related with each local coordinate system. Throwing forms were classified into four groups according to subjective judgments of three men (subjects A, B, and C) who were experienced in baseball. (1)Over Hand Delivery (OHD), 2)Three Quarter Delivery (TQD), 3)Side Arm Delivery (SAD), 4)Under Hand Delivery (UHD). The kinematic differences, pelvis, trunk, upper arms, forearms, hands, and non-throwing side of the thigh were represented by Euler angle sequence. To determine the validity of the classification each form was evaluated quantitatively using the previous method.
    Results: The throwing form classifications were OHD: 80, TQD: 127, SAD: 29, UHD: 4 by sub A, OHD: 84, TQD: 122, SAD: 29, UHD: 5 by sub B, OHD: 139, TQD: 70, SAD: 26, UHD: 5 by sub C. Kinematic results showed statistically significant differences by multiple comparison tests, the upper arm horizontal abduction/adduction, the trunk rotation/lateral bending, and the pelvis lateral bending/tilt/rotation (p <0.05).
    Conclusion: The upper arm abduction/adduction and the elbow flexion/extension angles are equivalent at BR regardless of throwing forms. The trunk lateral bending/rotation had statistically significant differences between each group. Trunk delivery is one of the most important factors to determine the throwing form. To treat throwing injuries, it is necessary to understand the kinematic characteristics of throwing motion.
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  • プロ野球投手の肩甲帯機能と障害発生因子：僧帽筋下部の重要性
    田中 稔, 佐藤 克巳, 永元 英明, 井樋 栄二, 山本 宣幸, 黒川 大介, 熊谷 純
    2012 年 36 巻 3 号 p. 1023-1027
    発行日: 2012年
    公開日: 2012/10/25
    DOIhttps://doi.org/10.11296/katakansetsu.36.1023
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    Background: The purpose of this study was to determine a characteristic of scapula function and factors related to throwing disorder in professional baseball pitchers.
    Methods: This study included 35 professional baseball players (21 pitchers and 14 fielders) who underwent a new medical checkup system in spring camp of March 2010. Shoulder and scapula function consists of 12 factors: (1) scapula-spine distance, (2) scapular retraction test, (3) scapular stability test, (4) muscle strength of the lower trapezius, (5) active compression test, (6) impingement signs, (7) Internal rotation from 3rd to 2nd position, (8) full can test and empty can test, (9) combined abduction test, (10) horizontal flexion test, (11) hyper external rotation test, and (12) elbow push test. Trunk, hip, and foot function consists of 6 factors: (1) modified trunk rotation test, (2) hand knee opposite test, (3) straight leg raising test, (4) range of motion of internal rotation of the hip, (5) heel-buttock distance, and (6) looping gait. These parameters were compared between the pitchers and the fielders.
    Results: The following parameters showed significant differences: 1) scapular retraction test was positive in 57% of the pitchers versus 21% of the fielders; 2) scapular stability test was positive in 61% (pitchers) versus 14% (fielders); and 3) muscle weakness of the inferior trapezius was observed in 81% (pitchers) versus 35% (fielders). Shoulder and/or elbow disorders occurred in 12 pitchers (57%) during the following season.
    Conclusion: Among professional baseball pitchers, limitation of scapula retraction and muscle weakness of the lower trapezius are more likely to lead throwing disorders.
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治療法
  • 腱板断裂関節症に対する人工骨頭置換術および人工肩関節置換術
    酒本 佳洋, 田中 康仁, 森本 光俊, 橋内 智尚, 桜井 悟良, 二階堂 亮平, 水掫 貴満, 仲川 喜之, 井上 和也
    2012 年 36 巻 3 号 p. 1029-1032
    発行日: 2012年
    公開日: 2012/10/25
    DOIhttps://doi.org/10.11296/katakansetsu.36.1029
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    Background: The purpose of this study was to evaluate the clinical outcome after hemiarthroplasty (HHR) and total shoulder arthroplasty (TSA) using small diameter head, which have been performed on older cuff tear arthropathy (CTA) patients.
    Methods: From 2006, seventeen patients with CTA were treated operatively.Of those, 7 patients did not have superior humeral escape and those patients were treated with HHR or TSA using small diameter head. There were 1 male and 6 female patients. The average age at the time of surgery was 76.1 years old (ranged 72-81 years). Depuy Global Advantage was used in all cases. All humeral stems were non-cemented types. Patients were evaluated based on JOA scores, range of motion and X-ray. Patient follow-up averaged 15.7 months (ranged 6-28 months).
    Results: Patients showed significant improvement in JOA score (46.2 to 80.7), forward flexion (70 degrees to 122 degrees) and external rotation (17 degrees to 51 degrees). All patients were satisfied with diminished pain. There was no hardware loosening or superior migration.
    Discussion: HHR and TSA using small diameter head with cuff repair appeared to provide reasonable short-term results for older cuff tear arthropathy patients. This method remains the treatment of choice for functional recovery.
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症例報告
  • 鏡視下修復術を行った HAGL 病変の 3 症例
    筒井 求, 伊藤 岳史, 花村 浩克, 岩堀 裕介, 梶田 幸宏, 佐藤 啓二
    2012 年 36 巻 3 号 p. 1033-1036
    発行日: 2012年
    公開日: 2012/10/25
    DOIhttps://doi.org/10.11296/katakansetsu.36.1033
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    The purpose of this study was to report the short term results of arthroscopic repair of humeral avulsion of the glenohumeral ligament (HAGL) lesion.
    We retrospectively evaluated three cases with HAGL lesion treated by arthroscopic repair between 2009 and 2011. Preoperative MR arthrography (MRA) showed a positive J sign on the oblique coronal image. There was one case with Bankart lesion and one case with rotator cuff tear. The mean follow-up period was 14 months. The humeral detachment of the inferior glenohumeral ligament (IGHL) was arthroscopically seen in all cases. Adequate visualization of the HAGL lesion was obtained with the 70° arthroscope with the arm internally rotated. The HAGL lesion was repaired with a suture anchor placed at the humeral insertion of the IGHL through an anteroinferior portal. Additional repair was also performed for Bankart lesion and rotator cuff tear.
    Postoperative CT showed improper anchor placement in two cases with the anchor inserted with the arm internally rotated, and the proper anchor placement in one case with the anchor inserted with the arm externally rotated. Postoperative MRA showed a negative J sign and the normal tension of the IGHL. The average JSS instability score improved from 52.0 preoperatively to 85.3 postoperatively.
    MRA was useful for the pre and postoperative evaluation for the HAGL lesion. For viewing thoroughly HAGL lesion, a 70° arthroscope was useful. Utilization of anteroinferior portal and anchor insertion with the arm externally rotated is necessary for proper anchor placement.
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  • アメリカンフットボール選手に発症した上腕骨頭軟骨損傷の２例
    向井 章悟, 中川 泰彰, 田中 慶尚
    2012 年 36 巻 3 号 p. 1037-1040
    発行日: 2012年
    公開日: 2012/10/25
    DOIhttps://doi.org/10.11296/katakansetsu.36.1037
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    The symptoms of cartilage injury of humeral head are not well known. We experienced two cases of traumatic cartilage injury of humeral head in American football players.
    Both cases were young(21 and 20 years old), male college American football players and they were both running backs. The first case complained of motion pain for 1 year since he had fallen on his left shoulder after a tackle. This case showed osteoarthritic change and impression fracture of humeral head. The second case complained of pain and felt a click in abduction-external rotation after a blunt hit on his right shoulder by tackle one week before. The MRI showed Bankart lesion and cartilage injury of humeral head.
    In both cases, full thickness cartilage defects of humeral head were observed and these lesions were engaged to the anteroinferior edge of glenoids when the shoulders were abducted and externally rotated. They were treated by arthroscopic Bankart repair and returned to the sports after standard rehabilitation. Now they are relieved of their symptoms.
    There are few reports of cartilage injury of humeral head because the diagnosis is difficult without arthroscopy. These two lesions are located in the posterior portion of humeral head, which is different from typical Hill-Sachs lesions. There are cartilage lesions in anterior glenoid in both cases, which may induce the symptoms such as subluxation or click in abducted-external rotated position. These cases reveal that cartilage injury of humeral head is not rare in high-energy injury, especially in collision sports.
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  • 腱板不全断裂に対し単独に鏡視下肩峰下除圧を施行した治療成績
    大灘 嘉浩, 福田 公孝, 杉本 寿司
    2012 年 36 巻 3 号 p. 1041-1044
    発行日: 2012年
    公開日: 2012/10/25
    DOIhttps://doi.org/10.11296/katakansetsu.36.1041
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    Partial rotator cuff tears are very common, but little is known about the MRI findings after the sole arthroscopic subacromial decompression (ASD).
    We evaluated the clinical outcome and T2MRI findings after ASD in 57 patients with 59 shoulders who had partial rotator cuff tear. The average age was 57.0 years old. Clinical results were evaluated with Japanese Orthopaedics Association score (JOA score). MRI were classified according to Matsuura's classification (Type 1: abnormal signal type, Type 2: abnormal signal and swelling type, Type 3: cut off end type, Type 4: tapered end type).
    The average JOA score increased postoperatively, from 66.8 points to 89.3 points. Regarding the MRI findings, 36 shoulders (92%) out of 39 shoulders of Type 1 remained showing Type 1. 7 shoulders (59%) out of 12 shoulders of Type 2 changed to Type 1, 4 shoulders (33%) remained showing Type 2, and 1 shoulder (8%) changed to Type 3. All 3 shoulders at Type 3 changed to Type 1. 1 shoulder (20%) out of 5 shoulders at Type 4 remained showing Type 4, and 4 shoulders changed to complete rotator cuff tears. The average postoperative JOA score was 90.3 points for Type 1, 95.2 points for Type 2, 86.8 points for Type 3, and 74.6 points for Type 4.
    The clinical outcome of ASD for partial rotator cuff tears was mostly satisfactory. The cases of Type 4 changed to complete rotator cuff tears at a high rate, and had a worse result.
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  • 再手術を行った鏡視下腱板断裂修復術後 knot impingement の 3 例
    梶田 幸宏, 岩堀 裕介, 佐藤 啓二, 花村 浩克, 筒井 求
    2012 年 36 巻 3 号 p. 1045-1048
    発行日: 2012年
    公開日: 2012/10/25
    DOIhttps://doi.org/10.11296/katakansetsu.36.1045
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    We occasionally experienced erosion of the inferior surface of the acromion after arthroscopic rotator cuff repair (ARCR). At present, the underlying mechanism of knot impingement after ARCR is fully unknown.
    We report three cases of repeated arthroscopic surgery for acromial erosion that developed after ARCR.
    Case1 was a 49-year old fireman. Case2 was a 56-year old woman who was a piano teacher, and Case3 was a 44-year old housewife. All cases had partial or full thickness rotator cuff tear and underwent ARCR using double row fixation. Postoperatively all cases achieved good range of motion recovery. However in all cases dullness and mild pain on elevating the arm continued after surgery. Therefore we performed revision arthroscopic surgery.
    On arthroscopic evaluation, sutures of the medial row had failed in all cases, the acromial erosion site was brushed by the loose suture end of lateral row in case 1 and case 2, and a broken suture had adhered to the floor of the acromial erosion in case 3. After removing the sutures, most of their symptoms disappeared.
    This study suggested that there is a possibility of the brushing of the end of a thread being a cause of prolonged symptoms, in addition to knot impingement and chemical reaction of the thread particles.
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  • 肩峰偽関節のため著明な外転筋力低下を生じた Floating shoulder の一例
    鈴木 昌, 鈴木 一秀, 西中 直也, 山口 健, 上原 大志, 永井 英, 筒井 廣明
    2012 年 36 巻 3 号 p. 1049-1051
    発行日: 2012年
    公開日: 2012/10/25
    DOIhttps://doi.org/10.11296/katakansetsu.36.1049
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    Nonunion of the acromion is considered as an indication for surgery because of reducing the abductor muscles. We report a case of nonunion of the acromion and the coracoid process of the scapula with severe muscle weakness.
    A 40-year-old man fell down and was admitted to another hospital under the diagnosis of multiple traumas including a left shoulder contusion. Because his left shoulder pain and active ROM were not improved with conservative treatment, he was referred to our hospital five months after the injury. The ROM in left shoulder was 90° of active flexion, 30° of active abduction with lateral shoulder pain. The abduction strength was weakened of MMT grade 3-. Radiograph showed a fracture of the distal end of the clavicle, the coracoid process and the acromion. CT showed no callus formation in the fracture parts of the coracoid process and the acromion.
    The surgical treatment was performed six months after the injury. The coracoid process was fixed with a screw, and acromion was fixed using tension band wiring method with autologous bone graft. The LIPUS was performed just after surgery. Bone union was obtained over 1 year after the operation. The ROM was improved to 160° of active flexion, 160° of active abduction, and abduction strength was also improved MMT 4.
    In this case, bone healing took more than one year. It is considered to devise fixation methods like plating and any other bone graft techniques.
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  • 多骨性Fibrous Dysplasiaに伴う上腕骨小結節骨折変形治癒に対する 骨切り術の１症例
    桐村 憲吾, 最上 敦彦, 塩田 有規
    2012 年 36 巻 3 号 p. 1053-1056
    発行日: 2012年
    公開日: 2012/10/25
    DOIhttps://doi.org/10.11296/katakansetsu.36.1053
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    We report on a case of malunion of the lesser tuberosity after humerus surgical neck fracture with polyostotic fibrous dysplasia which caused limitation of range of motion.
    A 38-year old man fell down on a ski slope. Original radiographs and CT showed Neer classification proximal humerus type 3-part fracture with severe displacement of the lesser tuberosity and he was affected with polyostotic fibrous dysplasia. First we had difficulty treating fibrous dysplasia by surgery, we made the choice of non-operative treatment. The facture was healed after seven months, but the limitation of ROM remained. CT showed that there was a malunion of the lesser tuberosity, resulting in limitation of adduction and internal rotation. The lesser tuberosity with subscapularis tendon was osteotomied from the humeral head. The lesser tuberosity was re-attached to its original part of humeral head with pull-out technique where we used the stronger type suture (#2, UltrabradeTM, Smith & Nephew) and processed spider staple (Japan MDM).
    Bone defect caused by the resection and curettage of bone tumor was filled with artificial bone paste and β-TCP.
    Bone union was obtained within four months. At 6 months follow up, he had returned to work and demonstrated a significant improvement in ROM.
    The proximal humerus fractures in bones affected with fibrous dysplasia often don't require operations since they heal without difficulty. But if there is malunion of the lesser tuberosity which causes limitation of range of motion, pull-out technique with the strong type suture and processed spider staple is a useful method.
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  • 肩単関節炎で発症し病理結果が感染と診断された多発関節炎の一例
    山川 晃, 田崎 篤, 森田 亘, 黒田 栄史, 星川 吉光
    2012 年 36 巻 3 号 p. 1057-1061
    発行日: 2012年
    公開日: 2012/10/25
    DOIhttps://doi.org/10.11296/katakansetsu.36.1057
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    The initial symptoms of connective tissue disease sometimes present as arthritis of the shoulder. We experienced a case of seronegative spondyloarthropathy(SpA) starting from the shoulder. It was difficult to distinguish infection and connective tissue disease due to the similar clinical presentation.
    A 44-year-old man was admitted with the complaint of persistant left shoulder pain with a duration of four months. Physical examination revealed motion pain and morning pain. The leukocyte count was 6700/μl and CRP 3.86 mg/dl. MRI showed hydroarthrosis with synovial proliferation. Arthroscopic synovectomy showed nonspecific synovial proliferation. Pathological findings of the synovium demonstrated granulomatous change with neutrophil invasion, suggesting purulent synovitis. Cultivation surveys showed negative findings. Thenceforth he started to complain of pain in the contralateral shoulder and bilateral ankles. We suspected the cause to be connective tissue disease at first, but serological examinations of RF, ANA and anti-CCP Ab were all negative. He was treated with antimicrobials for six weeks, but symptoms persisted and laboratory data did not improve. Therefore, after ruling out the possibility of infection, we diagnosed SpA. After introducing Azulfidin, his clinical course and inflammatory signs showed a reduction.
    The initial symptoms of connective tissue disease sometimes present as arthritis of the shoulder. In some cases, it is difficult to distinguish infection and connective tissue disease, due to the similar clinical presentation. Treatment with immunosuppressive drug is contraindicated for infection. We believe that it is important to follow the clinical course and rule out infection first in such cases.
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  • B 群溶連菌による化膿性肩鎖関節炎の 1 例
    大灘 嘉浩, 福田 公孝, 杉本 寿司
    2012 年 36 巻 3 号 p. 1063-1066
    発行日: 2012年
    公開日: 2012/10/25
    DOIhttps://doi.org/10.11296/katakansetsu.36.1063
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    A septic arthritis of the acromioclavicular joint is very rare, and 18 cases could be found in the literature. We experienced one case and performed surgical treatment on this case.
    A 50-year-old woman was admitted to our hospital complaining of severe pain in her left shoulder. The pain began the previous day and was accompanied by fever. The patient had no underlying disease. There was severe tenderness on her left acromioclavicular joint.
    The hematological examination revealed leukocytosis and C-reactive protein. The acromioclavicular joint showed an effusion on the MRI findings. Cultures from the acromioclavicular joint aspirate grew Group B streptococcus. On the fifth day from onset, we performed open irrigation and debridment, followed by distal clavicle excision. After 6 months the patient was free from pain and no limitation of movement was noticed.
    If antibiotics are not so effective, we suggested that adequate irrigation and debridment, followed by distal clavicle excision or resection arthroplasty of the acromioclavicular joint, lead to a good outcome.
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  • 上腕骨近位骨肉腫に対して pedicle freezing method を使用した 1 例
    上石 貴之, 堀 武生, 松本 里沙, 齋藤 知行
    2012 年 36 巻 3 号 p. 1067-1070
    発行日: 2012年
    公開日: 2012/10/25
    DOIhttps://doi.org/10.11296/katakansetsu.36.1067
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    Endoprosthetic replacement of the shoulder after resection of the tumor can provide good results, but there are problems about loosening and fracture around the stem. We report the use of pedicle freezing method for an osteosarcoma of the proximal humerus.
    A fifteen year-old man suffered from a metastatic osteosarcoma of the proximal humerus. The primary tumor occurred in his left fibula 6years previously, and he had undergone operations three times; left femoral amputation, right knee arthroplasty and left femoral hemi-arthroplasty. We performed an operation without using prosthesis, because we were afraid of loosening of the stem and fracture around the implant because of his large body (height 172cm, weight 87kg, BMI 29.4). We selected tumor resection and reconstruction using pedicle freezing method. The proximal humerus was exposed from head to proximal 2/3 after separating the muscles and tendons, and we soaked it in liquid nitrogen. After freezing, we reconstructed muscles and tendons with sutures.
    His shoulder range of motion was 60 degrees in elevation, 45 degrees in abduction at the last follow-up. His shoulder range of motion was restricted, however he could go to high school by himself.
    Pedicle freezing method has a merit of preservation of the patients own bone, but a demerit of degenerative formation of cartilage. In this case the patient had a limitation of shoulder function, but had no recurrence. Long-term follow-up may be mandatory to detect the occurrence of secondary osteoarthritis of the shoulder.
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  • 有痛性麻痺性肩関節亜脱臼に対し鏡視下安定化手術を行った 1 例
    﨑村 俊之, 古川 敬三, 梶山 史郎
    2012 年 36 巻 3 号 p. 1071-1074
    発行日: 2012年
    公開日: 2012/10/25
    DOIhttps://doi.org/10.11296/katakansetsu.36.1071
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    We report a case of painful paralytic shoulder subluxation treated successfully by arthroscopic Stabilization. A 54 year-old female with athetoid cerebral palsy. She had cervical spondylotic amyotrophy due to the involuntary movements associated with athetoid cerebral palsy. She had difficulty in elevating her right shoulder for 30 years. She also appeared in pain from passive shoulder movement for 10 years. Conservative treatment was performed at other hospitals, such as the use of a sling, but the gradual increase in pain led to her first visit to our hospital. Significant muscle atrophy and weakness showed in deltoid SSP ISP and biceps. Shoulder active elevation was impossible. Downward shoulder subluxation was shown in X-ray images. CT image did not show glenoid hypoplasia or bone loss, or bony changes of the humeral head. Pain was relieved by maintaining the position of the humeral head by manual reduction. It was thought that by performing surgery to keep reduction we could expect improvement in the symptoms. Arthroscopic surgery was performed. Plication to 1 cm between the posterior capsule and the labrum. The anterior labrum was detached from the glenoid and sutured according to suture anchor method while pulling superiorly. In addition rotator interval closure was performed. A sling was used during the first 2 weeks after surgery. Pain disappeared soon after surgery. At 1 year after surgery, reduction position of humeral head in X-ray images and improvement of pain was maintained. Arthroscopic stabilization for painful paralytic shoulder subluxation is considered a useful method for improvement of pain.
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  • 骨形成不全症に合併した反復性肩関節脱臼の 1 例
    酒井 忠博, 平岩 秀樹, 濱田 恭, 中島 基成
    2012 年 36 巻 3 号 p. 1075-1077
    発行日: 2012年
    公開日: 2012/10/25
    DOIhttps://doi.org/10.11296/katakansetsu.36.1075
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    The subject in this study was a 23-year-old male, who was right handed. When he was a child, he had several fractures on his femurs and was diagnosed as having Osteogensis Imperfecta (OI) type 1. When he was 16 years old, he smashed a ball while playing table tennis and dislocated his right shoulder. After a few years, he dislocated his right shoulder similarly and suffered from recurrent dislocation.
    At physical examination, he had general joint laxity with 5/5 of Carter's signs. However, anterior apprehension sign was positive only on the affected side of the shoulder. Because CT-arthrogram demonstrated there was the Bankart lesion, we performed arthroscopic Bankart repair. After 2.5 years, the JSS score improved from 64 to 97 points, and the Rowe score from 30 to 95 points. There has been no recurrence of the dislocation in the meanwhile, and no enlargement of the anchor holes on the 3D-CT.
    Osteogenesis Imperfecta is a heritable systemic disorder of bone and connective tissue characterized by bone fragility1), 2), which shares overlapping clinical features with the joint hypermobility syndrome3). However there is no report about the treatment for recurrent anterior shoulder dislocation in a patient with OI. On the other hand, there are several reports about the complications with intramedullary fixation at the time of osteotomies which are intra-articular, metaphysial, or extracortical rod migration4).
    Although the result of arthroscopic Bankart repair for this case was favorable, further observation will be needed.
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  • 肩甲骨周囲に発生した巨大なデスモイドの 2 例
    松本 里沙, 堀 武生, 上石 貴之, 齋藤 知行
    2012 年 36 巻 3 号 p. 1079-1081
    発行日: 2012年
    公開日: 2012/10/25
    DOIhttps://doi.org/10.11296/katakansetsu.36.1079
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    We experienced two cases of giant desmoid tumor around the scapula. Desmoid tumors are also known as aggressive fibromatosis. Resection, however, may be a challenge, because of a high frequency of postoperative recurrence.
    Case One: an 18-year-old man was examined for a giant mass on the his left of neck. Physical examination revealed limited shoulder range of motion and muscle weakness in his left arm. Radiographs showed a giant mass stretched from his neck to the ventral scapula. We performed marginal resection of the tumor, but the tumor recurred; therefore, we peformed resection again with radiation therapy.
    In case one at present, his shoulder range of motion is still limited, but the tumor has not recurred. Case Two: a 44-year-old woman was examined for a giant mass on her back. Physical examination revealed limited shoulder range of motion and muscle weakness in her right arm. Radiographs showed that the giant mass stretched from her back to the chest wall. We performed marginal resection of the tumor. And in case two at six months after surgery, the tumor had not recurred.
    We experienced two cases of giant desmoid tumor around the scapula. At present, there are no recurrences but dysfunction of the shoulder joint and cosmetic problems remained. In order to achieve better functional outcomes,an inter disciplinary approach may be mandatory, especially for large desmoid tumors occurring around the shoulder.
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  • 空気肩関節造影検査後，棘窩切痕部ガングリオン内に空気が貯留した一例
    村橋 靖崇, 廣瀬 聰明, 山下 敏彦, 岡村 健司
    2012 年 36 巻 3 号 p. 1083-1085
    発行日: 2012年
    公開日: 2012/10/25
    DOIhttps://doi.org/10.11296/katakansetsu.36.1083
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    Cases of spinoglenoid notch ganglion causing suprascapular nerve palsy have been well documented. Because labral tears were confirmed arthroscopically in all patients on whom we performed arthroscopic decompression in our institution, we think that the one way valve mechanism causes ganglion cysts. In this study, we describe a case suggesting the air broke into the ganglion cyst through the torn labrum by air arthrography. A 23-year-old female presented to our institution with right shoulder pain. Physical examination revealed no limited ROMs, less muscle strength of external rotation, and O'Brien's test and crank test were positive. Magnetic resonance imaging (MRI) demonstrated large multilocular cysts in which T1 weighted-imaging was low and T2 weighted-imaging was high from supraspinous fossa to infraspinous fossa. Computed tomography (CT) and MRI after air arthrography showed the presence of air in the ganglion cyst and between the glenoid and the superior posterior labral. Arthroscopic evaluation confirmed type 2 SLAP lesion extending from the 10:00 to the 12:30 position.
    The ganglion cysts were approached between the glenoid and detached labrum. An amber-colored fluid and air were evacuated when the cystic capsule was incised. The cystic capsules were excised and the superior labrum was repaired.
    Six months follow-up demonstrated complete relief of pain. MRI showed disappearance of the cysts, and no recurrences.
    In general, it is said that the ganglion cyst is formed by extra-articular mucin droplets coalescing from intra-articular synovial fluid. This case suggested that the detached labrum functioned as a check-valve from articular joint into the ganglion cyst.
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  • 変形による可動域制限を伴った上腕骨近位端骨折の治療経験
    西本 竜史, 林田 賢治
    2012 年 36 巻 3 号 p. 1087-1089
    発行日: 2012年
    公開日: 2012/10/25
    DOIhttps://doi.org/10.11296/katakansetsu.36.1087
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    We report a case of delayed union of 4-part valgus impacted fracture of proximal humerus with restriction of the range of motion caused by deformity which was satisfactorily treated with rotator cuff reconstruction procedure.
    A 37-year old man suffered a proximal humerus fracture by motorcycle accident. After conservative therapy for about two months, he consulted our hospital about prolonged severe pain and severe restriction of the range of motion. The X-ray and the CT showed valgus impacted humerus head and medially displaced fragments of both the greater and lesser tuberosity. In the operation, the humeral head and shaft were already fused in valgus position. The fragments of both the greater and lesser tuberosity were removed and the rotator cuff was repaired on the articular surface of which cartilage was removed.
    After 6 years, shoulder range of motion improved from 40 to 160 degrees in anterior elevation and from 10 to 60 degrees in external rotation. He was very satisfied with the clinical result.
    Although malunion of 4-part proximal humerus fracture is usually treated by prosthetic arthroplasty, we considered that the humeral head should be retained in younger patients such as this case. Corrective osteotomy was not performed because of the risk of necrosis. Some reports describe that the reconstruction of rotator cuff function is important in the treatment of the proximal humerus fracture and its malunion. We also believe that successful reconstruction of rotator cuff produced a good outcome.
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  • 肩甲骨関節窩骨折 Ideberg type V に対して鏡視下手術を施行した１症例
    酒井 健, 西中 直也, 永井 英, 山口 健, 上原 大志, 鈴木 一秀, 筒井 廣明
    2012 年 36 巻 3 号 p. 1091-1094
    発行日: 2012年
    公開日: 2012/10/25
    DOIhttps://doi.org/10.11296/katakansetsu.36.1091
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    Recent cases of glenoid fracture treated by arthroscopy have been reported. We experienced a rare case of glenoid fracture (Ideberg type V) which was treated with an arthroscopic procedure. Surgical treatment was required for accurate joint surface reduction and fixation to avoid further arthrosis and instability. Open procedures have been performed in previous case reports; however, we chose an arthroscopic technique.
    A 54-year-old man was injured in a traffic accident, sustaining a type V glenoid fracture as classified by Ideberg. Arthroscopic surgery was performed seven days after the injury. A cartilage defect was observed posteroinferior to the glenoid during arthroscopy. The bony fragment was lifted with Kirschner wire (K-wire) and the subchondral bone was supported and fixed using three percutaneous K-wires during the arthroscopic procedure. The K-wires were removed 12 weeks after surgery.
    He returned to his job as a teacher in one year. The clinical result was satisfactory (Japanese Orthopaedics Association score, 93 points). He underwent rehabilitation during the year following surgery.
    Open procedures have historically been reported for the surgical stabilization of glenoid fracture. Arthroscopic repair can be conducted with more accurate reduction, and fixation and is less invasive when compared with open repair. Although most of the published case reports have referred to Ideberg type I, the arthroscopic repair was also very effective for Ideberg type V. Inconclusion arthroscopic surgery was suitable for this case of Ideberg type V glenoid fracture and a good postoperative result was achieved.
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  • 保存的に治療した肩関節下方脱臼骨折の一例
    小川 健, 田中 利和, 野内 隆治
    2012 年 36 巻 3 号 p. 1095-1098
    発行日: 2012年
    公開日: 2012/10/25
    DOIhttps://doi.org/10.11296/katakansetsu.36.1095
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    Inferior dislocation of the shoulder joint is relatively rare, has been reported to be only 0.5% of the total of dislocations of the shoulder. We report on a large depressed fracture of the humeral head (Hill-Sachs like lesion) cased by dislocation of the shoulder joint inferiorly , and discuss it's treatment.
    A 46-year-old man, in the transportation industry Fell from the back of a truck and injured, his right shoulder. On X-ray, humeral head was dislocated to the inferior of the glenoid, and had a depressed fracture. Manual reduction was done at another hospital, the next day, he visited our hospital. Neurovascular injury symptoms were not present. Collapse of the humeral head occurred during anterior dislocation of the shoulder Hill-Sachs like lesion, in total lateral 2cm, rang in depth was 1cm. There was no Bankart like lision on the glenoid cavity. After one week, in X-ray taken under stress, inferior instability was minimal; fracture compliance was good for the glenoid cavity in abduction position. Therefore, conservative treatment was continued.
    After 1 year, the JOA score was 100 points. X-ray, of the depressed fracture of the humerus showed union, and no change in osteoarthritis. Inferior instability of the shoulder was not seen. The MRI showed no rotator cuff tear, and no labrum damage.
    The present case is a large Hill-Sachs like lesion showed whether or not surgical fixation of a depressed fracture is needed, there has been no detailed report about this in the past. Good results were obtained selecting conservative treatment.
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  • 第 1 肋骨疲労骨折による胸郭出口症候群の 1 例
    伊奈 沙織, 二村 昭元, 若林 良明, 中川 照彦, 宗田 大
    2012 年 36 巻 3 号 p. 1099-1102
    発行日: 2012年
    公開日: 2012/10/25
    DOIhttps://doi.org/10.11296/katakansetsu.36.1099
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    We experienced an extremely rare case of thoracic outlet syndrome (TOS) caused by fatigue fracture of the first rib. Case: A 25-year-old male, semi-professional volleyball player, he complained of numbness and weakness of the left upper extremity. Eden-Test, Morley-Test, and Wright-Test were positive on the left. X-ray showed bilateral first rib fractures (non-union on the left side), which was likely caused by heavy muscle training. 3D-CT suggested that the dynamic movement of the pseudoarthrosis following the fatigue fracture was developing incomplete brachial plexus palsy.
    We performed a surgical decompression by supraclavicular approach without clavicle osteotomy.
    Compression of the brachial plexus by the dynamic movement of the non-union site was observed. We resected the rib apporoximately 3cm in total.
    His symptoms had resolved completely after the operation, and he has no problems in playing volleyball.
    Only a few cases of TOS due to the first rib fracture that has been treated surgically, have been reported. It usually involves the lower trunk of brachial plexus, as we presented. Roos approach and supraclavicular approach are known for TOS operation. Clavicle osteotomy is usually required in the latter approach; however, the procedure seemed invasive for top athletes. Therefore, we chose a supraclavicular approach without clavicle osteotomy in this case. Through this approach, we could obtain a sufficient surgical field to decompress the brachial plexus. In conclusion, we experienced a rare case of TOS caused by non-union after fatigue fracture of the first rib in a volleyball player. Surgical treatment led to complete resolution of the symptoms.
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  • 大きな下方関節包断裂により腋窩神経が露出していた外傷性肩関節前方不安定症の 1 例
    小倉 誉大, 菅谷 啓之, 高橋 憲正, 河合 伸昭, 島田 憲明, 永井 宏和, 田中 基貴, 田巻 達也, 設楽 仁, 森石 丈二
    2012 年 36 巻 3 号 p. 1103-1105
    発行日: 2012年
    公開日: 2012/10/25
    DOIhttps://doi.org/10.11296/katakansetsu.36.1103
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    We present the case of an elite woman wrestler who suffered from recurrent shoulder instability induced by a large inferior capsular tear associated with an axillary nerve exposure after arthroscopic Bankart repair.
    A 20-year-old elite woman wrestler presented with right glenohumeral instability. The first time dislocation of the right shoulder was at the age of 18 during a wrestling match. Then she suffered from recurrent glenohumeral instability and underwent an arthroscopic stabilization.
    The initial stabilization surgery was very successful and she had returned to competition 6 months after the surgery. 14 months after the surgery she suffered a right shoulder injury when the opponent intentionally fell on the mat from clinching position. Her right shoulder was forced to hyperflex suddenly. Since then, she had been complaining of right shoulder instability. The second surgery demonstrated massive inferior capsular disruption associated with completely exposed axillary nerve. Type IV SLAP lesion and slight detachment of the anterior labrum were also observed. The disrupted capsule was carefully repaired using 3 side to side stitches and the nerve was anatomically reduced. SLAP and anterior labrum lesions were also repaired using suture anchors. Rotator interval closure was performed as an augmentation. Axillary nerve palsy was not confirmed either before or after surgery.
    The present case report demonstrated a unique case of shoulder instability associated with axillary nerve exposure due to a unique cause of injury, seen in an elite woman wrestler. Arthroscopy was quite an effective tool for safe and effective treatment as well as diagnosing this unique pathology.
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  • 肩峰偽関節を伴った cuff tear arthropathy の 1 例
    吉田 篤, 森澤 妥
    2012 年 36 巻 3 号 p. 1107-1110
    発行日: 2012年
    公開日: 2012/10/25
    DOIhttps://doi.org/10.11296/katakansetsu.36.1107
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    In a massive rotator cuff tear (mRCT), the shoulder function may be maintained by intact deltoid muscle, even if there is the arthropathy. We report a case of mRCT combined with pseudoarthrosis of the acromion, which had remarkable shoulder dysfunction.
    The patient was a 70-year-old man, whose right shoulder pain developed three years previously without injury. He had received an intra-articular injection of steroid, several times. At examination, he had supraspinatus and infraspinatus muscle atrophy, and biceps muscle deformity, and active shoulder elevation was limited to 30°. Image inspections showed ascent of the humeral head with rounding of the greater tuberosity, pseudoarthrosis of the thinned acromion, and mRCT with biceps tendon rupture(BTR). An operation was performed by acromion-splitting approach through pseudoarthrosis. The rotator cuff tear was repaired by tissue augmentation, and the pseudoarthrosis was fixed by tension band method using iliac bone graft. The pain was relieved and his active shoulder elevation improved to 120° at one year, postoperatively.
    It is thought that a possible cause of pseudoarthrosis is a stress fracture of the thinned acromion due to cuff tear arthropathy. Both impaired dynamic stabilizer due to the mRCT with BTR and loss of deltoid function due to the moveable acromion caused remarkable shoulder dysfunction.
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  • 肩関節に滑膜性骨軟骨腫症と関節症を生じた末端肥大症の 1 例
    松岡 朋代, 岩堀 裕介, 梶田 幸宏, 佐藤 啓二
    2012 年 36 巻 3 号 p. 1111-1114
    発行日: 2012年
    公開日: 2012/10/25
    DOIhttps://doi.org/10.11296/katakansetsu.36.1111
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    Clinical reports of osteoarthritis and synovial osteochondromatosis of the shoulder in with acromegaly are very rare, and only three cases could be found in the literature. We report a case with that disorder.
    The patient was a retired 70-year-old male. From 20 years previously, he had suffered from pain and limited motion in both shoulders. Plain radiography, CT, and MRI showed severe osteoarthritis and a large number of loose bodies in both shoulders, and a giant loose body in the right shoulder. He was diagnosed with osteoarthritis of the shoulder with synovial osteochondromatosis. Furthermore he had characteristic features of acromegaly. He was diagnosed with acromegaly based upon elevated serum levels of growth hormone (GH) and a pituitary tumor on brain MRI. We performed removal of the loose bodies and shoulder hemiarthroplasty on the right shoulder.
    His motion pain almost disappered and limited motion moderately improved after surgery.
    Our case had the following clinical characteristics of osteoarthritis and synovial osteochondromatosis with acromegaly as reported in literature; there was bilateral symmetric involvement and the osteochondromatosis was more extensive in number and size. GH may play a role as a trigger in the development of synovial chondromatosis in osteoarthritic joints and generate giant loose bodies.
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  • 肩峰下滑液包に発生した滑膜軟骨腫症に対する鏡視下手術の一例
    藤井 賢吾, 三上 容司, 東夏 奈子, 山本 真一
    2012 年 36 巻 3 号 p. 1115-1118
    発行日: 2012年
    公開日: 2012/10/25
    DOIhttps://doi.org/10.11296/katakansetsu.36.1115
    ジャーナル 認証あり
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    Synovial chondromatotis localized in the subacromail bursa has rarely been reported. We present a case of synovial chondromatosis of the subacromial bursa in a 75-year-old male, treated arthroscopically.
    A 75-year old male, who had suffered long head of the right biceps tendon rupture 3 years previously, gradually became aware of his right shoulder swelling. He had no pain on motion and no restriction of the range of motion, no tenderness, or heat of his affected shoulder. Plain X-ray of the shoulder showed scalloping of the acromion, and enhanced MRI and enhanced CT scans revealed the mass of the subacromial space and subdeltoid bursa. T1-weighted images of MRI showed subacromial-subdeltoid bursa filled with multiple low-isointensed nodules. The result of culture analysis and cytology by puncture of the mass only showed the presence of leukocytes. Arthroscopic surgery was performed. We removed about 1200 free bodies by forceps and irrigation from posterolateral and anterolateral portals. Synovectomy was also performed. Histological findings supported our clinical diagnosis.
    There was no complaint after surgery, and swelling of his shoulder disappeared.
    We think arthroscopic treatment is less invasive, so we can reduce the postoperative pain and restriction of ROM compared to open surgery, and also arthroscopic treatment may allow a better visualization of the subacromial space. There may be remnant of free bodies and abnormal synovium, so we must keep this in mind for recurrence and malignant transformation. Long term follow up is necessary.
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  • 激しい訓練後に著明な肩下方不安定性を生じた自衛官の１例
    入江 徹, 三好 直樹, 研谷 智, 伊藤 浩
    2012 年 36 巻 3 号 p. 1119-1122
    発行日: 2012年
    公開日: 2012/10/25
    DOIhttps://doi.org/10.11296/katakansetsu.36.1119
    ジャーナル 認証あり
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    We experienced a rare case of inferior shoulder instability caused by military training.
    A 22 year-old man, the Japanese Self-Defense Forces personnel, received repetitive and hard military training in May, 2007. Going on training, pain and apprehension of his left shoulder appeared gradually. He saw a local doctor then consulted us after twelve days from onset.
    His left shoulder subluxated to an inferior direction at rest, and reduced upward easily. There was no anterior or posterior instability, or general joint laxity. He had motor weakness of left shoulder girdles and ring, small fingers, and sensory disturbance on the medial side of his left arm. MRI arthrography of his left shoulder revealed abnormalities of superior labrum and anterior capsule. Electromyography of Deltoid and SSP muscles revealed slight abnormal activity, and motor nerve conduction velocity of median and ulnar nerve were normal.
    We diagnosed him as having inferior shoulder instability due to brachial plexus palsy, so called “drooping shoulder”, and decided to treat conservatively. Immobilization of the left shoulder was carried out, symptoms improved gradually. After one year, shoulder arthroscopy was performed to check the structural disorder, but no abnormal finding was observed. After two years, his symptoms had almost recovered, but mild instability remained and he could not to serve in the force.
    Nerve disorder is differential diagnosis of inferior shoulder instability. We supposed it was main cause of this case, and chose conservative treatment. But it was possible a combination of structural disorder, and diagnostic arthroscopy should have been considered earlier.
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  • 肩鎖関節症に対する鏡視下鎖骨遠位端切除の 2 例 ∼ 術式の工夫
    古賀 龍二, 古島 弘三, 山本 譲
    2012 年 36 巻 3 号 p. 1123-1126
    発行日: 2012年
    公開日: 2012/10/25
    DOIhttps://doi.org/10.11296/katakansetsu.36.1123
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    Resection of the distal clavicle has remained the gold standard for acromioclavicular joint disease. We report two cases of arthroscopic resection of the distal clavicle for acromioclavicular joint pathology.
    In the first case a 58 year old man complained of right shoulder pain which had not been reduced by conservative treatment at another hospital. X-ray showed acromioclavicular joint osteoarthritis and MRI showed imcomplete tears of the rotator cuff. Arthroscopic rotator cuff repair and resection of the distal clavicle (6mm) was performed. In the second case a 76 year old woman complained of serious pain and limitation of ROM in the right shoulder from 2 months previously. X-ray showed upward movement of humeral head and MRI showed massive tears of the rotator cuff and effusion of the acromioclavicular joint. There was soft tissue mass continuously at the acromioclavicular joint, with a low signal on T1 and a high signal on T2, 2.0cm×1.5cm in size. Arthroscopic resection of the distal clavicle (10mm) with concomitant subacromial decompression and synovectomy was performed. During the resection, we found a flow of yellow fluid.
    We performed arthroscopic resection of the distal clavicle for acromioclavicular joint pathology in two cases and got good results.
    We thought that the volume of the resection should not exceed 10mm. Neviaser portal was useful to approach the acromioclavicular joint. We used Codman chisel diameter for the decision of the width of the resection.
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  • 肩関節傍関節唇嚢腫に対する鏡視下切除術の成績
    大泉 尚美, 末永 直樹, 船越 忠直
    2012 年 36 巻 3 号 p. 1127-1130
    発行日: 2012年
    公開日: 2012/10/25
    DOIhttps://doi.org/10.11296/katakansetsu.36.1127
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    Paralabral cyst is one of the causes of suprascapular nerve palsy at the spinoglenoid notch. We have been performing arthroscopic excision of paralabral cyst since 2005. The purposes of this study were to assess postoperative results and to evaluate recurrence of the cyst.
    Eight shoulders of 8 patients were included in this study. All were men and their age at the time of operation was 19-51 years old (avg: 35.8 years old). In all shoulders, paralabral cyst existed near the postero-superior labrum and spread to the spinoglenoid notch. Postero-superior labral tear existed in 7 shoulders. Labral tear was repaired in 3 shoulders of which the labrum at the attachment of the long head of biceps tendon was unstable. In 4 shoulders, debridement of the torn labrum was performed. Postoperative JOA score, MMT of supraspinatus and infraspinatus, and sensory disturbance of suprascapular nerve area were evaluated. Recurrence of the cyst was investigated on MRI at the final follow-up. The average follow-up period was 22.3 months (range, 12-56).
    Postoperative JOA score was 91-100 points(avg: 97.1). Preoperatively, decreased MMT of supraspinatus and infraspinatus were observed in 6 shoulders; postoperatively, all but 1 shoulder showed full MMT. Sensory disturbance was observed in 3 shoulders preoperatively, and all shoulders showed intact sensation at the final follow-up.
    Arthroscopic excision of paralabral cyst is low-invasive compared to an open procedure. It is considered to be a useful method that demonstrated satisfactory clinical results and no recurrence of the cyst.
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  • 肩甲骨体部骨折に対する手術治療経験
    －上角及び下角骨折の2例－
    森岡 健, 高橋 正明, 河野 友祐
    2012 年 36 巻 3 号 p. 1131-1134
    発行日: 2012年
    公開日: 2012/10/25
    DOIhttps://doi.org/10.11296/katakansetsu.36.1131
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    We report 2 cases of osteosynthesis for scapular body fractures. One is a superior angle fracture, and another is a inferior angle fracture. Both are fractures with a separation of more than 10mm.
    In the first case a 42-year-old man injured his left shoulder in a fall during soccer game. Scapular Y roentgenography revealed superior angle fracture displaced approximately 12mm superiorly from the scapular spine. Operation was performed 10 days after injury.
    In the second case a 68-year-old man was injured in a bicycle accident. 3DCT imaging showed a large fragment containing inner border to be dislocated superiorly approximately 14mm from angulus inferior scapulae. Osteosynthesis was performed 9 days after the accident.
    In the first case the active ROM of the left shoulder was 160° in flexion, 40° in external rotation,and Th10 level in internal rotation at 3 months after surgery. In the second case the active shoulder ROM was 140° in flexion, 50° in external rotation,and Th12 level in internal rotation at 3months after surgery.
    Nordqvist et al reported that 57% of the patients with residual scapulae displacement (> 10mm) had shoulder symptoms after conservative treatment of the scapular body fractures. Although there are different opinions, we chose surgical treatment to avoid malunion.
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  • 肩関節拘縮に対して鏡視下関節包解離術を施行した1例における再鏡視下の関節内構造体の変化
    小泉 宏太, 林田 賢治, 田中 誠人
    2012 年 36 巻 3 号 p. 1135-1138
    発行日: 2012年
    公開日: 2012/10/25
    DOIhttps://doi.org/10.11296/katakansetsu.36.1135
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    The efficacy of arthroscopic capsular release for patients with frozen shoulder has been reported in several papers. However, we have never found papers which refer to the postoperative change of the intra-articular structures.
    We had a patient with severe frozen shoulder treated by circumferential capsular release and had an opportunity of revision surgery to treat residual restriction of external rotation by arthroscopy. In this study, we report the intra-articular findings after arthroscopic capsular release.
    In the second look, we found a thick fibrous structure adherent to subscapularis tendon and thought it was the main pathology of the restriction of external rotation. After removing it, we recognized the improvement of external rotation. We also found atrophic capsular ligaments all around the labrum except the antero-superior portion. Especially, a severe atrophy of the anterior band of inferior glenohumeral ligament was observed.
    We were concerned about the possibility of dislocation after this surgery and the difficulty of the treatment if that happened. Therefore we should consider the proper indication and the range of the capsular release.
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