Background: We need to diagnose the rotator cuff tears and shoulder adhesive capsulitis at the first examination. The purpose of this study was to clarify the difference of physical findings between rotator cuff tears and shoulder adhesive capsulitis.
Methods: 247 patients were examined and diagnosed as having rotator cuff tears or shoulder adhesive capsulitis on MRI. The rotator cuff tears group consisted of 157 patients with 88 males and 69 females. The adhesive capsulitis group consisted 90 patients with 50 males and 40 females. Muscle atrophy, tenderness on palpation, delle on the greater tuberosity, shoulder active ROM (flexion, extension, abduction, external rotation and internal rotation), terminal pain, limitation of passive shoulder motion, shoulder strength, impingement sign, belly press test, and lift off test were examined and compared between the two groups.
Results: The average age of the rotator cuff tear group was 68 years and that of the adhesive capsulitis group was 59 years. The incidence of several findings showed the statistical differences between the two groups. The strength of abduction at 45 degrees, the strength of abduction at 90 degrees, the strength of external rotation, painful arc sign, delle on the greater tuberosity, atrophy of infraspinatus and the tenderness on palpation of the greater tuberosity were high in the Odds ratio. Shoulder ROM in adhesive capsulitis was statistically less than that in rotator cuff tears.
Conclusion: The weakness of shoulder abduction and external rotation would suggest rotator cuff tear. Especially, the loss of 45 degrees abduction strength was the physical finding for rotator cuff tear that had the highest accuracy. In addition, normal shoulder strength and the limitation of shoulder ROM would suggest adhesive capsulitis.

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Many authors have postulated various opinions about the etiology of glenohumeral Periarthritis. Based on our histological study of the rotator cuff in necropsy, and surgical and bursographical findings, we consider glenohumeral periarthritis to be in most cases subacromial bursitis secondary to the degeneration of the rotator cuff and subclinical tears in the cuff that are in the process of healing naturally.
A consecutive series of 127 shoulders in this category which were treated with local injection, acupuncture and physiotherapy from May, 1984, through April, 1988, were reviewed. Of those, 103 shoulders (81%) predominantly had symptoms of subacromial bursitis, while the other 24 (19%) had symptoms of bicipital tenosynovitis. Sixty-six shoulders (52%) were frozen with contracture while 61 (48%) were subject to freezing with. less contracture.
The average period from onset of treatment to clinical cure for the shoulders with predominant symptoms and signs of subacromial bursitis and bicipital tenosynovitis was 14.9 weeks and 22.9 weeks, respectively. The shoulders frozen with contracture required a longer treatment period, one of 22.3 weeks, than the less cntracted shoulders which required 10.3 weeks on the average. Eight shoulders (6%) remained moderately disabled in ADL at follow-up due to persisting pain or limited motion.

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The purpose of the present study was to investigate the intraarticular changes of the frozen shoulder as compared with those of the rotator cuff tears. Eight patients (nine shoulders) aged 43 to 75,4 males and 4females, were examined.
Arthroscopic observations were performed through a posterior portal under general anesthesia, followed by biopsies around the opening of the subscapularis bursa. Similar procedures were followed prior to the cuff repairs of 10 shoulders aged 41 to 65. Premanipulation diagnostic arthroscopy showed the humeral head to be tightly held againet the glenoid fossa in all the patients with frozen shoulder.
Vascular congestion existed in most cases around the opening of the subscapularis bursa, while the destructive changes were not recognized in any shoulder. Histologically, there was minimal synovial proliferation or infiltration of inflammatory cells, but proliferation of blood vessels was evident.

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A comparative study was done between range of motion and arthrography in 58 patients with so-called 50 kata. And muscle strength analysis on shoulder girdle was done by Cybex II dynamometer.
According to grade of contraction, shape of pooling shadow of inferior fold classified into four types. And shape of posterior joint space classified into three types. In patients of so-called 50 kata, pooling shadow of inferior fold was smaller than the other disease of the shoulder.
According to multiregression analysis, pooling shadow of inferior fold w as in relation to range of abduction and flexion on so-called 50 kata. Posterior joint space slightly related with the other motion except flexion. Pooling shadow of inferior fold was contributed by flexion, abduction, and external rotation, especially Flexion. Posterior joint space was slightly contributed by the other motion except flexion.
Cybex II dynamomenter revealed that the patients with so-called 50 kata attained less strength to strength healthy site in endurance. Especially strength of abduction was injuried.
On conclusion, it is intimate ralation between contraction of inferior fold a nd decrease of range of flexion on so-called 50 kata. And weakness of strength of abduction is remarkable on so-called 50 kata. So, on so-called 50 kata, it is necessary, increasing range of flexion and strength of abduction.

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現在まで五十肩(凍結肩)における病理学的報告は少ない。今回五十肩の病態を明らかにするために,関節鏡を使用して関節内の変化を検索し生検により滑膜の病理所見を検討した。対象は14例15肩で,年齢は平均56歳であった。罹病期間は平均5.6カ月,日整会肩関節疾患治療成績判定基準(以下JOA score)は平均51点であった。関節鏡視所見として五十肩では前方関節唇は軽度の摩耗までで関節構成体の変化は少なかった。滑膜は発赤し易出血性であり,上関節腔や肩甲下筋腱嚢付近で増殖していた。五十肩ではほとんどの症例で関節腔が狭く鏡視が困難であった。関節内滑膜の病理所見として血管増生は強く炎症細胞浸潤は軽度であった。また血管の拡張を伴いその中に血液のうっ滞が認められた。以上より五十肩は関節腔の狭小を伴い,関節腔内ではうっ血を特徴とする循環不全の存否が確認できた。

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Puvpose
In the diagnosis of the shoulder lesion, MRI is useful in demonstrating abnormalities in the soft tissue structures. But the so-called Gojukata is still diagnosed after other shoulder lesions are ruled out.

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Magnetic resonance (MR) imaging has been known as a useful tool for imaging the musculoskeletal system, especially spinal lesions, avascular necrosis, and the tumors of the bone and the soft tissues. However, there are only a few reports on MR imaging around the shoulder joint. We reported on the technique of MRI for the shoulder and typical MR imaging of the shoulder disorders at the society'is meeting last year. The "so called 50 kata" is a Japanese traditional term for periarthritis scapulohumerale in English. We have examined 19 shoulders in patients with "so-called 50 kata" using MR imaging since February in 1988 and compared the MR images of the disorder with those of other diseases. The typical MR appearance of "so-called 50 kata" is relatively high intensity of the supraspinatus tendon with the T₁-weighted and/or T₂-rweighted sequence, which resembles that of subacromial impingement syndrome.

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Purpose
The purpose of this study was to collect information about osteopenia in several parts of the shoulder joint from a series of individuals suffering from periarthritis of the shoulder. The BMD (Bone mineral density) was measured with a DEXA (Dual energy X-ray absorptiometray).
Materials and methods
In 30 cases of periarthritis of the shoulder,16 men and 14 women, the BMD of the shoulder joint was evaluated. The measurements were made of the head of the humerus, the greater tubercle of the humerus, the surgical neck of the humerus, and the neck of the scapula. The average age of the male patients was 58.4 years and 59.5 years for the females. The reference cases,9 men and 9women, randomly selected from people (range,24-62) without any history of disease in the shoulder joints, had their BMD measured.
Results
In the reference cases, the greater tubercle and female surgical neck, of the handedness, contained more mineral than did the contralateral one. Only in the cases of the women with periarthritis of the shoulder, the proxymal humerus of affected side, had less mineral than did the contralateral one. At the neck of the scapula, there were no significant differences in any of the cases.
Conclusion
The degree of osteopenia associated with periarthritis of the shoulder was significant in the proximal humerus of females.

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Purpose
The purpose of this study was to collect information about osteopenia in the upper end of the humerus from a series of individuals suffering from periarthritis of the shoulder. The BMD of the greater tubercle of the humerus in cases of periarthritis of the shoulder and in the reference cases was measured by using DEXA (Dual energy X-ray absorptiometry).
Materials and methods
In 18 cases of periarthritis of the shoulder,10 men and 8 women, the bone mineral density of the greater tubercle of the humerus was evaluated. The average age of the patients was 56.5 years for the men and 57.6 years for the women.
The reference cases,9 men and 9 women, randomly selected from people (range,24-62) without any history of injury or disease in the upper extremities, had their bone mineral density measured.
Results
In the reference cases, the humerus of the handedness contained more mineral than did the contralateral one. All the women with periarthritis of the shoulder were right-handed and in all but one it affected the right side. Except in one case, there was a significant decrease of bone mass in the affected side as compared to that of the unaffected one. In the cases of men with periarthritis of the shoulder, the humerus of the handedness had a tendency to contain more mineral than did the contralateral one. Age, range of motion and duration of the disease did not seem to influence the degree of osteopenia.
Condusion
(1) The BMD of the greater tubercle of the humerus was measured by using DEXA.
(2) The degree of osteopenia associated with periarthritis of the shoulder was significant in females. (3) In the reference cases, the mineral density was found to be higher in males and in the handed side.

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