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Kotatsu Urasaki, Fuminori Kanaya, Chojo Futenma, Kunio Ibaraki
1997 Volume 46 Issue 3 Pages
800-803
Published: September 25, 1997
Released on J-STAGE: February 25, 2010
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Two cases of traumatic subluxation of the carpometacarpal (CM) joint of the thumb are reported. The first case was caused by radial subluxation of the CM joint following forced extension and abduction of the right thumb. The patient was treated with taping, however, radial subluxation remained after 5 months. He then received intermetacarpal ligament reconstruction with a half slip of the extensor carpi radialis longus. At 15 months follow-up, the patient had neither pain nor instability and his CM joint was kept reduced on the radiograph.
The second case occurred after radial subluxation of the right thumb CM joint in a motor cycle accident. The patient had pain on pinching and showed radial subluxation even after receiving initial immobilization with a cast for 4 weeks. She was also treated by ligament reconstruction the same as the first case. At 9 months follow-up, she had no pain and her CM joint was kept reduced on the radiograph.
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Ken-ichiro Teramoto, Hidechika Nakashima, Tetsuya Hirano, Koji Takeda, ...
1997 Volume 46 Issue 3 Pages
804-808
Published: September 25, 1997
Released on J-STAGE: February 25, 2010
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Silastic Trapezium Implant Arthroplasty (STIA) for osteoarthritis of the trapezometacarpal joint is adapted from the Swanson prosthesis arthroplasty. We reviewed the result of this method, mainly in cases with mid to long-term follow-up.
From 1983 to 1996, 8 thumbs in 8 patients (1 male, 7 female) underwent treatment using the Swanson method. Patients ranged in age from 48 to 76 years (mean 63.3 years). Patients were classified according to the Eaton classification as follows; stage II in 4 thumbs, stage III in 4 thumbs.
Six patients complained of no pain, and 2 patients felt slight pain on motion. The average grip strength was 15.6kg (83.9% of unaffecte side). The average pinch strength was 11.9kg (82.6% of unaffected side). Postoperative roentgennogram showed no evidence of sinking or subluxation and rupture of the implant.
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Taisuke Kitamura, Takashi Ishinishi, Kosuke Ogata, Toshio Inoue, Osamu ...
1997 Volume 46 Issue 3 Pages
809-813
Published: September 25, 1997
Released on J-STAGE: February 25, 2010
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We investigated the relationship between Pinch strength and factors associated with activity of Rheumatoid Arthritis (RA). Subjects included 183 out-patients (366 hands) with RA who were hospitalized from April to June 1996 for at least one year. Pinch gauge (Baseline) which measures 0-5kg strength, and also grip strength were measured with an air bag connected to a mercurial column. 366 hands were assessed according to the classifications of Steinbrocker, Larsen, and Naelbuff. Results revealed that pinch strength correlated with grip strength. (Rt.: p<0.0001, Lt.: p<0.0001) However pinch strength did not correlate with patient's age, disease duration, morning stiffness, and ESR. Pinch strength measurement with a pinch gauge was useful for evaluating RA activity. It was difficult to measure grip strength in patients with advanced RA. It was useful to measure the pinch strength in patients with severe joint mutilation or immediately postoperatively.
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Takashi Urasaki, Tsutomu Teruya, Hiroyuki Shimabukuro, Tomohiro Moriya ...
1997 Volume 46 Issue 3 Pages
814-816
Published: September 25, 1997
Released on J-STAGE: February 25, 2010
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We report the surgical result of replantation of amputated digits during a five year period. From January 1992 to September 1996, we had 24 patients (21 males and three females) with amputation of 40 digits (eight thumb, eight index fingers, twelve long fingers, six ring fingers, six little fingers). The patient's age ranged from four to 62 years (mean 40 years). Surgical delay from the time of injury ranged from three to 25 hours (mean seven hours). According to Tamai's classification of the territory of digital amputation, no patients were Zone I, three were Zone II, nine Zone III, 24 Zone IV and four Zone V. According to Yamano's classification of the amputated condition, there were no sharp cut amputations, 34 blunt cut amputations, five avulsion cut amputations and one crush cut amputation.
Success rate of replantation in this series was 92% (37 of 40 digits). Failed replantations included amputation in Zone II (blunt cut and avulsion cut one each) and a crush cut amputation in Zone V. The territory of amputation and condition of the amputated digits had a greater affect on success rate than the surgical delay.
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Issaku Toyohara, Fuminori Kanaya, Yoshisada Shingaki, Kunio Ibaraki
1997 Volume 46 Issue 3 Pages
817-821
Published: September 25, 1997
Released on J-STAGE: February 25, 2010
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We report a case of extension contracture of thumb, index and long fingers due to an anomalous fibrous band of the extensor indicis proprius (EIP) and extensor medii proprius (EMP). The patient was a 42 year-old male, who complained of difficulty in flexing the left thumb, index and long fingers with the wrist in a neutral to flexed position. This extension contracture of digits was noticed from junior high school without any history of trauma or infection and has not progressed since then. MRI revealed a T1, T2 low intense band-like structure deep to the extensor muscles. Intraoperative findings revealed fibrous bands of the EIP and EMP causing the extension contracture, and short extensor pollicis longus (EPL) and extensor digitorum communis (EDC) muscles. Z elongation of the EPL and section of the EIP and EMP tendons were performed. After surgery a forearm cast with thumb outorigger was applied for 3 weeks. Pathological findings of the fibrous band were identical to tendon and the EMP showed myogenic degeneration. After surgery the patient could fully flex his digits with the wrist in neutral.
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Akihiko Asami, Tomoko Higo, Toshiyuki Tsuruta, Keizo Morisawa, Hideo W ...
1997 Volume 46 Issue 3 Pages
822-826
Published: September 25, 1997
Released on J-STAGE: February 25, 2010
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Motoyuki Fujisawa, Osamu Soejima, Hiroyuki Iida, Masatoshi Naito, Kosu ...
1997 Volume 46 Issue 3 Pages
827-829
Published: September 25, 1997
Released on J-STAGE: February 25, 2010
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Over a three year period (1994-1996), we performed 18 carpal tunnel releases in long-term hemodialysis patients. Six of these patients were a second carpal tunnel release group, with their symptoms recurring 1 to 8 years (mean: 4.3 years) after their first carpal tunnel release. In this study we reviewed the difference between the first carpal tunnel release group and the recurrent group.
Although, there was no significant difference between the two groups in regard to preoperative objective symptoms and the number of distal motor latencies, complications appeared to be a prominent feature in the recurrent group.
Microscopic examination showed amyloid depositions in the membranous tissue surrounding the median nerve in the recurrent group and this may cause the recurrence of symptoms.
We conclude that it is necessary to follow patients after re-operation because factors which prevent recurrence are still unclear.
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Shun Komine, Akio Matsuzaki, Masaki Kido, Hiroshi Nakamura, Hirofumi H ...
1997 Volume 46 Issue 3 Pages
830-833
Published: September 25, 1997
Released on J-STAGE: February 25, 2010
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Two patients with compression neuropathy of the superficial radial nerve are presented.
Case 1: A 71 year-old female visited our clinic in November, 1995 with a one month history of pain in the dorsum of both hands.
Clinical examination revealed paresthsia on the radial half of the dorsum of her hand and tenderness on dorsal area of the distal forearm, where the superficial radial nerve pierced the deep fascia of the forearm. The patient was operated on after failure of conservative treatment for Cheiralgia Paresthetica.
At exploration a membranous tissue traversing over the nerve was seen and incised, and a shallow indentation was seen on the nerve under the membrane.
After the operation her pain disappeared and has not recurred.
Case 2: A 38 year-old male presented in 1991 with dysesthesia on the dorsum of his right hand and a tumor on the dorsum of his right forearm.
He also reported pain on the dorsal side of his right hand. Three years later he recognized a small tumor on the dorsal side of his right distal forearm and dysesthesia on the dorsum of his right hand. Examination revealed sensory loss limited to the area supplied by the superficial radial radial nerve and a tumor on the dorsal side of his right forearm.
Partial resection of the tumor and neurolysis was carried out, under the diagnosis of a compression neuropathy of the superficial radial nerve due to a forearm tumor.
The pathological diagnosis was a nalignant fibrous histiocytoma.
The patient's pain disappeared after the operation but recurred one month later. The patient died four months later due to lung metastasis.
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Koji Goto, Tatsuki Kashimoto, Kei Kondo, Keiji Fujio, Michio Yamanaka, ...
1997 Volume 46 Issue 3 Pages
834-837
Published: September 25, 1997
Released on J-STAGE: February 25, 2010
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It has been well recognized that direct injection into the trigger-point of the piriformis muscle using local anesthetic-steroid mixtures is effective in the management of piriformis syndrome. However we have found it difficult to accurately advance the needle into the piriformis muscle. We discovered a new more accurate method of performing the injections using ultrasonographic imaging. With this method we treated two patients who were diagnosed clinically as piriformis syndrome. First we had the patients lie in the prone position, and comfirmed the depth and site of the piriformis muscle using ultrasonographic imaging. Under imaging control, injections into the muscle belly using a spinal needle were performed with local anesthetic only or local anestheticsteroid mixtures. These injections were repeated once a week as many as eight times until the symptoms subsided. The results were satisfactory.
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Kazutaka Matsunaga, Akio Matsuzaki, Yasuhiro Aramaki
1997 Volume 46 Issue 3 Pages
838-840
Published: September 25, 1997
Released on J-STAGE: February 25, 2010
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The authors studied the course of the infrapatellar branch of the saphenous nerve in 36 cadaver legs, with particular reference to its relationship to the sartorius muscle. In 19 (52.8%) the infrapatellar nerve passed through the sartorius, in 15 (41.7%) it passed over the sartorius before distributing to the antero-medial aspect of the knee. In two the nerve branched: in one both branches penetrated the sartorius and in the other, one branch penetrated and the other passed over the sartorius. The authors could not find any case in which the nerve passed through the tendon of the sartorius or passed under the sartorius. These findings explain why few cases of entrapment neuropathy of the infrapatellar branch clinically need surgical treatment.
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Akira Mori, Akio Matsuzaki, Masayoshi Kido, Yasuhiro Aramaki
1997 Volume 46 Issue 3 Pages
841-844
Published: September 25, 1997
Released on J-STAGE: February 25, 2010
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The anterior tarsal tunnel syndrome is an entrapment neuropathy of the deep branch of the peroneal nerve beneath the inferior extensor retinaculum.
The authors surgically treated seven cases of anterior tarsal tunnel syndrome. Two male and four female patients ranged in age from 10 to 80 years.
After failure of conservative therapy (steroid in filtrated into trigger point, vitamin B1 and B12 medication the patients underwent surgery.
The patients complained of pain or paresthesia in the dorsum of the foot and the first interdigital space.
At exploration, the causes of compression were as follows: cicatricial, thickened membranous tissue over the head of the tales in four cases, anterior protrusion of the anterior edge of the distal tibia in two, tendon of the extensor hallacis muscle in two, adhesion and scar tissue in one.
In all cases sensory recovery occurred with in a few days after the surgical decompression.
The authors believe that sitting in the Japanese style is one of the causes of extrusion.
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Akinori Sakai, Katsumi Suzuki, Masataka Goto, Yasushi Takeda, Toshitak ...
1997 Volume 46 Issue 3 Pages
845-848
Published: September 25, 1997
Released on J-STAGE: February 25, 2010
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Since 1984, we have treated 10 hands with Kienböck's disease at Lichtman's stage IV by replacing the lunate with a palmaris longus tendon ball. There were 9 cases (7 males, 2 females), whose ages ranged from 24 to 61 years (average 41.0 years). 5 right lunates and 5 left lunates were involved. All patients were right-handed. The period of follow-up ranged from 3 months to 6.75 years (average 3 years and 5 months). We evaluated the postoperative results clinically and radiologically.
All of the 9 patients were able to return to their previous jobs. There was no significant change in the postoperative range of motion of the wrist joint. Clinical results were evaluated as excellent in 6 hands, good in 3 hands and fair in one hand according to Dornan's criteria, and satisfactory in 7 hands and unsatisfactory in 3 hands according to Lichtman's criteria. The mean preoperative ulnar variance was -0.70mm and there was no cases with plus variance. Carpal height ratio significantly changed from 0.493 preoperatively to 0.466 postoperatively (p=0.092). Most cases had a significant decrease in carpal height ratio one month after the operation. Radio-scaphoid angle did not change postoperatively.
In conclusion, the replacement operation using the tendon ball was clinically effective for stage IV Kienböck's disease, but radiologically carpal height ratio decreased early after surgery.
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Yoshifumi Nagatani, Noboru Yamamoto, Masatsugu Suehiro, Kotaro Imamura ...
1997 Volume 46 Issue 3 Pages
849-851
Published: September 25, 1997
Released on J-STAGE: February 25, 2010
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A series of 18 lunate and perilunate dislocations were retrospectively studied. Treatment consisted of closed reduction in three patients, open reduction and internal fixation in fifteen patients. The median time from injury to treatment was 27 days. Delay of treatment had an adverse effect on the clinical results. In cases treated early, the clinical results were almost satisfactory, with a mean Cooney's clinical score of 81 points. In chronic cases who were treated for more than 6 weeks standing, the mean clinical score was 70 points. However, three of four chronic cases had satisfactory outcomes (more than 65 points). Therefore open reduction to treat chronic lunate and perilunate dislocations should be considered rather than proximal row carpectomy.
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Kunihiko Okano, Takuo Hayashi, Hiroshi Inoue, Sin'iti Harada, Kazuhiro ...
1997 Volume 46 Issue 3 Pages
852-854
Published: September 25, 1997
Released on J-STAGE: February 25, 2010
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The Clyburn Dynamic Fixator has a ball and socket type joint that makes it possible to have early wrist joint motion while holding the comminuted fracture of the distal end of radius in a reduced position. We treated 18 fractures of the distal end of the radius with the Clyburn Dynamic Fixator from 1992 to 1996. According to the Flykmann classification, up to 70% of all of these fractures were type VII and VIII. Postoperative results were evaluated using Saito's criteria. Fifteen fractures had excellent and three fractures good results. The mean period from external fixation to the beginning of joint motion was 21 days (range, 9-28 days). One case which had shortening of the radius after beginning joint motion 14 days after surgery, was reducted again, followed by two months fixation without joint motion. This case had a bone defect around the fracture area, which required a bone graft with external fixation.
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Ryuichiro Kikuno, Masahiro Nakagawa, Kazuharu Yoshinaga, Toyo Maehara
1997 Volume 46 Issue 3 Pages
855-858
Published: September 25, 1997
Released on J-STAGE: February 25, 2010
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We follow-up 11 patients for 2-20 months (average 10 months) after using a bioabsorbable poly-L-lactide (PLLA) screw and pin. The screw was used in 2 ankle fractures, 1 PCL avulsion fracture, 1 total hip arthroplasty. The pin was used in 1 MP joint fracture, 2 PIP joint fractures, 1 patella fracture, 2 radial head fractures, and both the pin and screw were used in one femoral head fracture. Bone union was achieved in all but one case.
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Hiroshi Takeda, Setsuo Urata, Hidechika Nakashima, Hiroyuki Yonemitsu
1997 Volume 46 Issue 3 Pages
859-861
Published: September 25, 1997
Released on J-STAGE: February 25, 2010
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Subcutaneous rupture of the brachial triceps tendon is relatively rare. To our knowledge, there have been 21 reports within the Japanease literature. We report a case of subcutaneous rupture of the brachial triceps tendon. A forty-one year old man fell on his left elbow, and complained of severe pain and swelling on his olecranon. Clinical examination and X-ray films showed rupture of the brachial triceps tendon, therefore surgery was performed. The triceps tendon was sutured to the olecranon with a non-absorbable suture. Clinical examination of the patient 7 month after surgery revealed almost normal elbow function except for slight loss of extension, allowing the patient to return to his usual activities.
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Hironobu Koseki, Nobuyuki Ito, Masao Eto, Tadashi Tomonaga, Hironori H ...
1997 Volume 46 Issue 3 Pages
862-866
Published: September 25, 1997
Released on J-STAGE: February 25, 2010
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Thirteen cases of elbow joint fracture dislocation in children treated at our hospital were reviewed clinically. There were 11 males and 2 females with an average age of 10.9 years. (range; 5-15 years). The average follow-up period was 8 years 10 months (range; 6 months-22 years). There were posterior dislocation in 8 cases, lateral dislocation in 2, anterior dislocation in 1, and 2 unknown types. Complicated fractures were mainly associated with medial epicondyle fracture in 6 cases and other fractures in 7 cases. The dislocation was reduced in all cases on the same day of the injury. Fracture treatment consisted of 2 conservative and 11 surgical intervention.
They were evaluated by JOA score, then correlation between JOA score and age at injury, dislocation type, fracture type, method of treatment, immobilization period, and follow-up period were investigated.
Postoperatively, average JOA score was 92.1 points (range; 74-100). Only immobilization period showed a significant correlation with the JOA score with a co-efficient correlation of 0.44. Moreover, considering the range of movement, only the flexion angle had significant relationship with immobilization period (correlation coefficient 0.55).
From this study it can be suggested that reduction and osteosynthesis should be carried out as early as possible. Moreover, the elbow should not be immobilized no longer than it is necessary.
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Nobuyuki Ito, Masao Eto, Tadashi Tomonaga, Hironori Hara, M. E. Rabbi
1997 Volume 46 Issue 3 Pages
867-870
Published: September 25, 1997
Released on J-STAGE: February 25, 2010
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Cubitus varus deformity is one of the most common complications associated with supracondylar elbow fractures. Madsen and Flynn et al reported that the rotational deformity at the fracture site was an important factor in varus deformity, and Madsen reported that ulnar displacement and angulation of the distal fragment might cause the same deformity.
In 1993, we reported a useful method to measure humeral torsion using ultrasonography in the reduction of a supracondylar fracture. From 1990, eleven patients were treated by percutaneous pinning using sonography. In this article, we report the follow-up study of these patients.
At follow-up, the carrying angle of the affected side was 0 to 16 degrees with an average of 7.5±4.8 degrees and that of the sound side was 5 to 16 degrees with an average of 8.8±3.8 degrees. The average degrees of extension and flexion of the affected side were 6.6 and 137.1 degres, respectively. There was no statistical difference between the sound and affected side.
According to these good results, we recommend the use of ultrasonography in treating supracondylar fractures to prevent cubitus varus deformity.
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Kaori Fukushima, Shinya Maki, Yujirou Hamasato, Kenji Fukumura, Yasuhi ...
1997 Volume 46 Issue 3 Pages
871-873
Published: September 25, 1997
Released on J-STAGE: February 25, 2010
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We report a new operative method for impending severe malunion of the upper limb in adolescence. Patients were six males ranging in age from 4 to 22 years (average; 12.8 years). There were two supracondyle fractures of the humerus, epiphyseal injury of the distal radius, metaphyseal fracture of the distal radius, fracture of the phalangeal neck, and olecranon fracture in one case each. The interval between injury and operation ranged from 14 to 70 days (average; 32 days). Our operative methods were composed of excision of the callus, reposition of the fracture fragments and osteosynthesis. Bone union was obtained in all cases, and there were no complications. In conclusion, our operative method seems to provide a favorable treatment for impending malunion of the upper limb in adolescence.
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Manabu Tokeshi, Fuminori Kanaya, Chojo Futenma, Kunio Ibaraki
1997 Volume 46 Issue 3 Pages
874-877
Published: September 25, 1997
Released on J-STAGE: February 25, 2010
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We report a case in which a bone bridge was formed at the distal radial epiphysis after an intra-articular comminuted fracture. The patient was a 7 year-old boy who sustained a comminuted intra-articular fracture (epiphyseal injury) to his left distal radius after falling from a height of 4 meters'. He received closed reduction and percutaneous pinning. He showed a malunited intra-articular fracture and bone bridge formation at the distal radial epiphysis on his first visit to our clinic. Before surgery, the ROM of the left wrist was 15° in extension and 30° in flexion. X-p films revealed the malunited intra-articular fracture with bone bridge at the distal radial epiphysis. There was no radio-lunate motion on X-p films and intra-articular adhesion of the radio-lunate joint was suspected by arthrogram. We corrected the malunited intra-articular fracture by reducing malunited fragments with resection of the bone bridge and a succeeding free fat graft. One year after surgery, growth of the distal radial epiphysis was 4mm in the left radius and 5mm in the right. Two years after surgery, extension improved to 55° and flexion improved to 70°.
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Toru Andou, Naoya Tajima, Etuo Chosa, Shoichi Kawagoe, Norio Sonoda, J ...
1997 Volume 46 Issue 3 Pages
878-883
Published: September 25, 1997
Released on J-STAGE: February 25, 2010
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This study evaluated MRI findings of the shoulder joint before and after pitching. Subjects comprised 8 males ranging in age from 19 to 27 years. Six of the subjects had a long history of playing baseball and two of these six were pitchers complaining of shoulder pain when pitching or after throwing a ball. Magnetic resonance imaging was performed before and after throwing 100 balls at full speed. In T2 weighted images after pitching, the intensity of the Numeral head, glenoid cavity and m. subscapuralis was significantly higher than that before pitching. In T2 weighted images of the subacromion in m. supraspinotus after pitching, the intensity of the pitching group showed a much higher tendency than that of the non pitcher group. This shidy confirmed the efficiency of using magnetic resonance imaging to assess the shoulder joint during pitching.
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Mako Hirano, Kazutoshi Nomura, Noburo Hashimoto, Tetsuya Fukumoto, Sug ...
1997 Volume 46 Issue 3 Pages
884-889
Published: September 25, 1997
Released on J-STAGE: February 25, 2010
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We examined MRI findings in patients with periarthritis of the shoulder. We excluded cuff tears, calcified tendinitis, instability of the shoulder, fracture and impingement syndrome of young patients. Subjects camprised 36 cases, 38 shoulders(25 men and 11 women), with an average age of 59.1 years (42-75). Scanning was performed on a Gyroscan T5-II 0.5-T (Philips). T1-weighted and T2-weighted sequences in the coronal oblique plane, T2-weighted sequences in the coronal sagittal plane and horizontal plane were taken.
Twelve shoulders showed some change in the humeral heads. Degeneration of the rotator cuff was observed in 15 shoulders. Joint fluid collection was observed in the gleno-humeral joints of 15 shoulders, in the subacromial bursa of 11 shoulders and in the acromio-clavicular joints of 7 shoulders. Twenty four shoulders had fluid collection in the sheath of the long head of the biceps long tendon. Localized high signal area was observed around the inferior pouch in 11 shoulders. We studied the relationship between MRI findings and clinical symptoms. There was no significant relationship but the shoulders with night pain and severe contractures had a higher positive rate of joint fluid collection on MRI than the shoulders without night pain and with less contractures.
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Takashi Miyamoto, Nobuyuki Ito, Masao Eto, Takashi Tomonaga, Hironori ...
1997 Volume 46 Issue 3 Pages
890-893
Published: September 25, 1997
Released on J-STAGE: February 25, 2010
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There are rarely few reports on the clavicular motion during elevation of the extremity. This is may due to the complicated shape of the clavicle and its three-dimensional movement. The purpose of this study is to analyze the movements of clavicle by using X-ray fluoroscope.
The study was performed on a 21 years old female who had clavicular fracture a year ago and had fixation with plate and screws. She had no difference on both shoulder ROM when examined. In front of X-ray fluoroscope, she was asked to abduct her arm to full in 10 seconds, and the movements were recorded on videotape. From the location of plate and screws we analyzed the clavicular motion.
The clavicle rotated clockwise in its long axis when viewing from the left sagittal plane. This movement increased constantly during the elevation of arm and reached 50 degrees at maximum abduction. In Frontal view, 25 degrees of upward movement was observed, where the majority of the movement was seen within 90 degrees of elevation.
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Hironori Hara, Nobuyuki Ito, Masao Eto, Tadashi Tomonaga, M. E. Rabbi, ...
1997 Volume 46 Issue 3 Pages
894-897
Published: September 25, 1997
Released on J-STAGE: February 25, 2010
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This study investigated the relation ship between the slope and shape of the acromion and the spur at the antero-inferior surface of the acromion no clarify the cause of subacromial impingement. This investigation was performed with 205 scapular dry bone specimens. The specimens of 107 males were used. Their ages ranged from 20 to 83 years with an average age of 56.5 years. The presence of acromial spurs was identified. All acromions were classified visually as type I (flat), type II (curved) or type II (hooked) as described by Bigliani et al. And the slope of the acromion was measured in all specimens.
A spur at the antero-inferior surface was seen in 96 acromions (46.8%). And almost all spurs were located in the anterior one third of the acromion. In all specimens, fifty-six acromions (27.3%) were type I, one hundred and eight (52.7%) were type II and forty-one (20.0%) were type III. The type of acromion was not related to the presence or absence of a spur. The average slope of all acromions was 46±8°, that of acromions with spur was 44±7° and that of acromions without spur was 49±8°. There was a significant difference between the slope of the acromion with spur and acromions without spur. From this study it can be concluded that the type of acromion had no relation ship to subacromial impingement and the flattened slope of the acromion might be one cause of subacromial impingement.
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Koichi Adachi, Nobuyuki Ito, Masao Eto, Tadashi Tomonaga, Hironori Har ...
1997 Volume 46 Issue 3 Pages
898-902
Published: September 25, 1997
Released on J-STAGE: February 25, 2010
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This study elucidated the factors causing spur formation at the greater tuberosity and lesser tubercle of the humerus.
260 shoulder joints of 138 preserved skeletons were investigated. The average age at the time of death was 58.7 years (range, 20-86 years).
Presence of spur in the acromion and in the tuberosities of the humerus were observed macroscopically. The angle formed by the tangent line of the front of the condyles and that of the bicipital groove was also measured.
The incidence of spur formation was statistically higher with increasing age. There was a statistical relationship between presence of spur at the humerus and also at the acromion.
According to Neer, elevation of the arm in the anatomical position of external rotation causes the critical area to pass under the anterior process of the acromion. However, this study revealed that the presence of more spurs in the tuberosities makes the humerus statistically internally rotated. Therefore, it may be suggested that the incidence of bony spurs is not only due to impingement, but rotation of the humerus and other factors are also responsible.
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Masao Eto, Nobuyuki Ito, Tadashi Tomonaga, Hironori Hara, Mohammad Ehs ...
1997 Volume 46 Issue 3 Pages
903-908
Published: September 25, 1997
Released on J-STAGE: February 25, 2010
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The avascular necrosis of the humaral head is less common than femoral head necrosis. The purpose of this study is to evaluate the patients with atraumatic avascular necrosis of the Numeral head, clinicaly and radiologicaly.
Six patients (11 shoulders) were examined. Among them 4 patients had femoral head necrosis as well. Predisposing causes were steroid therapy in 6 shoulders of 3 patients and caisson disease in 5 shoulders. There were 4 males and 2 females. The average age was 47 years (33 to 59 years). The mean follow-up period was 7 years 5 months. Six shoulders were treated coservatively and in 5 shoulders arthroplasty was performed.
In the radiographic examination, 10 shoulders had normal articular surface (stage I), one had deformed articular surface (stage II) and no osteoarthritis (stage III) at first visit. Progression of the radiographic stage was observed in 9 shoulders. clinical results were evaluated by JOA score. The average JOA score of non-operated patients at initial examination was 88.7 and at the recent examination that was 87.8. On the other hand, in patients with arthroplasty the average JOA score improved from 54.8 to 84.7. (excluding one case).
Initially subchondral translucent line or linear opacity were seen in most of the cases which were progressive. Patients with severe pain (JOA score below 70) required arthroplasty and a satisfactory results were obtained except one case.
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Mohammad Ehsanur Rabbi, Nobuyuki Ito, Masao Eto, Tadashi Tomonaga, Hir ...
1997 Volume 46 Issue 3 Pages
909-914
Published: September 25, 1997
Released on J-STAGE: February 25, 2010
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Ken Takeda, Mitsuru Takeshita, Kenichi Aramaki, Toshihiro Ogami
1997 Volume 46 Issue 3 Pages
915-918
Published: September 25, 1997
Released on J-STAGE: February 25, 2010
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We reviewed 3 patients treated for calcific tendinitis with subluxation of the shoulder joint.
All patients were females with an average age of 58.7 years Patients complained of severe rest pain and inability to perform active elevation.
Calcifications were found along the Rotator cuff tendons with part of them leaking out to the Subacromial bursa (SAB) on X-ray film, and the humeral heads were dislocated inferiorly by subluxation.
After a few injections of steroid to the SAB, symptoms and calcifications were reduced and humeral heads had been completely repositioned.
In subjects with no loosening, no cuff tears, and no paralysis of the axillary Nerve, we considered the main factor causing inferior subluxation of the shoulder joint to be dysfunction of the deltoid and Supraspinatus muscles to avoid pain.
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Tetsu Yamaguchi, Koji Midorikawa, Yozo Shibata, Kosuke Ogata
1997 Volume 46 Issue 3 Pages
919-923
Published: September 25, 1997
Released on J-STAGE: February 25, 2010
JOURNAL
FREE ACCESS
We treated a patient with impingement syndrome due to a huge acromial osteophyte. The patient was a 69 year old female who experienced pain when elevating her shoulder joint after backstroke swimming. On presentation, she was able to actively flex her shoulder to 100 degrees. The X-ray showed a huge osteophyte in the anterio-lateral edge of the acromion. Arthrogram and MRI did not show a rotator cuff tear. Her shoulder pain was relieved by a local anesthetic injection into the subacromial bursa (SAB). However shoulder eleuation was not improved and we there fore decided to use ASD. Following this treatment, the patent experienced no pain, and a full range of motion was restored to her shoulder achieving a satisfactory result.
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Tomoki Yuasa, Yozo Shibata, Koji Midorikawa, Ken Takeda, Tatsuhiro Shi ...
1997 Volume 46 Issue 3 Pages
924-928
Published: September 25, 1997
Released on J-STAGE: February 25, 2010
JOURNAL
FREE ACCESS
DePuy total shoulder replacements were performed on two patients for glenohumeral osteoarthritis.
Patients were 69 and 72 year old females both of whom suffered from severe right shoulder pain and disability. Plain X-ray films revealed severe osteoarthritic changes in both patients, but arthrogram and MRI did not show a rotator cuff tear.
The fixation of each components was as follows. Glenoid components were fixed with cement, but humeral components were press-fitted without cement. DePuy's humeral component is capable of tissue-ingrowth and has four fins on the component to ensure rotarory stability. On the fourth post operative day, passive range of motion exercises were started.
The follow-up period was one year and ten months in each case. The results were evaluated according to J. O. A score. Both patients achieved pain relief and improved their shoulder range of motion. Radio lucent line around the glenoid component was recognized on X-ray films at an early post operative state.
But one year after surgery, the width of this lucent line had not increased. Although follow-up is relativery short, both patients are satisfied with their shoulder function.
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Hideki Morita, Yasunori Fuchigami, Kazuo Kaneko, Toshihiko Taguchi, Yu ...
1997 Volume 46 Issue 3 Pages
929-933
Published: September 25, 1997
Released on J-STAGE: February 25, 2010
JOURNAL
FREE ACCESS
Motor evoked potentials (MEPs) following transcranial magnetic stimulation and evoked spinal cord potentials following transcranial electrical stimulation (TE-ESCPs) were recorded in 14 patients with cervical myelopathy. MEPs were recorded from the biceps brachii (BB) and the abductor digit minimi (ADM) muscles. Central motor conduction time (CMCT) was also measured by subtracting the peripheral conduction time from the onset latencies of the MEPs. By comparing CMCT with TE-ESCPs, we studied the adequacy of the clinical diagnosis of the level of cervical myeiopathy using MEPs.
In all 11 patients with abnormalities of TE-ESCPs at C3/4, C4/5 or C5/6 level, CMCT for the ADM were abnormally prolonged. In both patients with abnormalities at C3/4 level, CMCT for the BB were also prolonged. CMCT by MEPs from the BB and the ADM are valuable in the functional assessment of central motor pathway and may also be useful in the clinical diagnosis of cervical myelopathy.
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