The purpose of this study was to compare patients with recurrent anterior dislocation and subluxation of the shoulder who were treated with a modified inferior capsular shift method with those treated with an arthroscopic Bankart suture repair. 51 shoulders were surgically treated. The patients were divided into 2 groups. In group M (21 shoulders), modified inferior capsular shift method was performed, and in group B (30 shoulders), arthroscopic Bankart suture repair was performed. The groups were homogeneous in gender, dominance, age, age at 1st dislocation (subluxation), number of dislocations or subluxations, time elapsed between 1st dislocation (subluxation) and surgery. The average follow-up for group M was 15.1 months, and for group B, it was 17.7 months. The postoperative rehabilitation was the same in both groups. Follow-up evaluations included JOA, Constant, JSS-SSI, Rowe shoulder scores and limitation of range of shoulder motion. Statistical analysis of data was performed using Welch's t test (significance for P <0.05). In group M, one of the 21 patients had experienced apprehension in the follow-up period, but no patients had a dislocation. In group B, 2 (6.7%) of the 30 shoulders experienced a dislocation. The follow-up JOA, Constant, JSS and Rowe shoulder scores of the 2 groups were not significantly different. The only significant difference seen between the 2 groups was for range of motion evaluation with the Constant score and JSS-SSI score. The mean value for group M was significantly greater than that for group B (Constant; p=0.036, JSS; p=0.028,). Though the follow-up reported was short, arthroscopic Bankart suture repair was an effective surgical technique as well as the modified capsular shift method. In our study, Bankart suture repair was superior for an internal rotation and flexion than a modified inferior capsular shift method.

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肩関節疾患の治療法として，注射やリハビリテーションによる保存療法が第一選択として挙げられる．代表的な肩関節周囲炎や肩腱板断裂では，肩関節痛と可動域制限を認めることが多い．その鑑別として問診，視診，触診，理学検査（肩関節可動域・筋力・誘発テスト）および超音波検査が挙げられる．本稿では肩関節における代表的疾患を説明し，これらの疾患に対する評価の進め方について解説する．

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The purpose of this study was to evaluate the clinical results after surgical repairs of the rotator cuff tear with time.24 shoulders in 24 patients with a rotator cuff tear underwent cuff repair and were followed up for 2 years postoperatively. The mean age of the patients was 59.7 years old. There were 22 men and 2 women. A complete rotator cuff tear was found in 20 shoulders and an incomplete one in 4. All patients underwent subacromial decompression and McLaughlin procedure except one with an incomplete tear. The patients were evaluated according to the JOA shoulder score and abduction power in pain, function, and ROM with time. A decrease of shoulder pain and functional improvement of the shoulder joint were observed 3 months after the operation, compared with that preoperatively. In comparison with preoperative status, ROM in the shoulder joint got worse 3 months after the operation and improved one year and 6 months postoperatively. Abduction power 6 months after postoperation was greater than the preoperative power. After a rotator cuff repair, improvement in range of motion was slow, compared with that in pain, shoulder function and abduction power.

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The purpose of this study was to evaluate the functional results after surgical repair of rotator cuff tears using the rate of improvement for muscle force of shoulder abduction. Thirty-eight shoulders in 38 patients with a rotator cuff tear underwent cuff repair. Abduction power of the shoulder was evaluated with spring scale preoperatively and 6 months after operation. There were 29 males and 9 females. Their averaged age was 61.2 years old. Duration of symptoms averaged 28 months. Twenty-nine patients had obvious trauma. Eighteen patients had a subacromial spur. Based on the intraoperative tear size, patients were classified into 2 groups (S group: partial thickness tear and full thickness tear<3cm, L group: full thickness tear≥3cm). Using the rate of improvement before and after surgery, we compared the results with sex, age, duration after tear, with or without subacromial spur and trauma and tear size. There was a significant difference in abduction power of the shoulder between the trauma group and the non-trauma group. The surgical outcome after a rotator cuff repair in the trauma group was better than that in the non-trauma group.

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The purpose of this study was to compare the outcome of patients who underwent rotator cuff repair using all arthroscopic or mini-open repair techniques. The type of this study is a retrospective comparative study. We retrospectively reviewed 30 patients who underwent either arthroscopic or mini-open rotator cuff repair. 15 patients underwent mini-open repair and 15 patients had arthroscopic repair. All patients had medium size tears. The outcome of 2 groups was evaluated using range of motion (elevation, abduction, external rotation), Japanese Orthopaedic Association (JOA) score, abduction power and Visual Analogue Scale (VAS) with time (preoperative, 3 months, 6 months and 12 months after the operation). No significant difference between the 2 groups were found for any variable preoperatively. JOA score had improved in both groups postoperatively. Abduction power had improved in arthroscopic group. Arthroscopic group showed a significant improvement in abduction power at 3 and 6 months after the operation. Arthroscopic group showed a significant improvement in elevation and JOA score at 6 and 12 months after the operation. In both groups, the clinical outcome had improved postoperatively. In this short-term outcome, the elevation and JOA score of arthroscopic group were improved earlier than those of mini-open group.

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The purpose of this study was to elucidate the relationship between shoulder girdle disorders of baseball players and the Hara test. We investigated 133 pitchers of the Gunma High School Baseball Association. The check lists were as follows: shoulder pain at the time of pitching; Hara test ( eleven items ). The correlation between shoulder pain at the time of pitching and each check list were examined. 31 pitchers had shoulder pain at the time of pitching. The significant relations were as follows: SSP test; impingement test; horizontal flexion test (HFT); elbow push test ( EPT ); hyper external rotation test ( HERT ). We thought that the useful check lists were the SSP test, impingement test, HFT, EPT and HERT. According to the logistic regression analysis,SSP test and impingement test and HERT were important items about shoulder girdle disorders of baseball players

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The purpose of this study is to identify the risk factors which affect the consecutive onset of throwing shoulder injury of a collegiate baseball team, and to calculate regression formula which could predict the future onset.
Prospective study. The subjects are 69 asymptomatic collegiate baseball players. We executed medical checkups and investigated who got throwing shoulder injury during this year. We did logistic regression analysis with the medical checkup findings and the data of the onset and found out the factors which significantly affected the onset. We also calculated Odds ratio of these factors and regression formula which predict the probability of the onset of throwing shoulder injury and evaluated the validity of regression model.
52%(36/69 cases) of the players suffered throwing shoulder injury during this year. Among the medical checkup findings of asymptomatic phase, pitcher and catcher, past history of throwing shoulder injury, abnormality of scapula-humeral rhythm, heel-buttock distance were thought to be the risk factors which were near-related to the onset of throwing shoulder injury. We calculated regression formula using the medical checkup findings of asymptomatic phase and we could predict the onset of throwing shoulder injury with 82.5% accuracy.
In order to prevent this injury, the method used in this study could be useful for field players to predict the onset of throwing shoulder injury.

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Operative treatment was recommended for great tuberosity fracture of the humerus with more than 5mm-upper displacement. The purpose of this study was to compare the operative treatment with conservative treatment of great tuberosity fracture of the humerus displaced between 5mm and 1cm. We retrospectively evaluated ten shoulders in 10 patients with great tuberosity fracture of the humerus. In all patients, there were 5mm∼10mm-displaced fragments of great tuberosity fracture of the humerus. The operative group was consisted of 5 shoulders (3 males and 2 females). Their mean age was 55 (47-71) years old. The average duration of follow-up was 16.2 (12-24) months. The conservative group had 5 shoulders (5 females). The mean age was 67.4 (61-73) years old. The average duration of follow-up was 24.8 (6-47) months. We evaluated the range of motion (flexion, abduction, external rotation) and the JOA score. In the operative group, flexion was 143±25.6°, abduction was 144.4±25.2°, ER was 34.4±15.7° and the JOA score was 84.3 points. In the conservative group, flexion was 138±34.2°, abduction was 131±24.1°, ER was 35±15.4° and the JOA score was 83.6 points. There were no significant differences between the operative group and the conservative group. In this study, we have the same clinical results for operative treatment and conservative treatment of the great tuberosity fracture of the humerus with more than 5mm-upper displacement.

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A rotator cuff tear is classified into a full thickness tear and a partial thickness tear. Various visual analog scales (VAS) of the shoulder joint in cases of rotator cuff tear were evaluated preoperatively. These scales included evaluations at night, at the time of exercise and at the time of rest. The purpose of this study was to examine the characteristics of each VAS evaluation into 3 types of rotator cuff tears. Since January 1999, 123 patients of rotator cuff tears were operated on in our institute, and 86 of them were evaluated preoperatively about their VAS. Their mean age was 61.8 years and the mean affected period was 20.2 months. There were 52 males, and 34 females. Each case was classified into the articular side tear group (group A), the bursal side tear group (group B) and the complete tear group (group C). The VAS evaluations of each group were statistically evaluated (The Tukey-Kramer method). There was not significant difference between the age and affection period of each group and there was significant difference about various VAS evaluations.

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The purpose of this study was to elucidate the relationship between shoulder girdle disorders of baseball players and the Hara test. We investigated 134 pitchers of the Gunma High School Baseball Association. The check lists were as follows: shoulder pain at the time of pitching; Hara test ( 11 items ). The correlation between shoulder pain at the time of pitching and each check list were examined. Furthermore, evaluation in zeroposition X-rays were examined. 31 pitchers had shoulder pain at the time of pitching. The significant relations were as follows: SSP test; impingement test; combined abduction test ( CAT ); elbow extension test ( EET ); elbow push test ( EPT ); hyper external rotation test ( HERT ). There was no significant difference between the types of zeroposition X-rays. We thought that the useful check lists were the SSP test, impingement test, CAT, EET, EPT and HERT.

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There are a lot of evaluation methods for a rotator cuff tear, but there are few reports that estimate these findings, generally paying attention to the tear type. The purpose of this study was to examine whether the type of tear in a rotator cuff tear could be distinguished from physical findings. We evaluated 89 cases 89 shoulders who had been surgically diagnosed as a type of tear and had been able to estimate all attempted physical findings. There were 54males and 35 females, 60 right sides and 29 left with an average age of 61.6 years old (35 to 85 years old). The subjects were divided into 3 groups by type of tear : an articular side tear(AST), a bursal side tear(BST), and a full-thickness tear(FTT). 24 values were obtained from the preoperative findings : muscle atrophy (trapezius or supraspinatus, infraspinatus, deltoid), tenderness (coracoid process, supraspinatus tendon, greater tubercle, intertubercular groove, anterior joint space, posterior joint space), muscle weakness (abduction, external rotation), active range of motion (flexion, abduction, external rotation, internal rotation), sulcus of suprasupinatus tendon, crepitus, Neer's impingement sign, Hawkins-Kennedy impingement sign, painful arc sign, Speed test, drop arm sign, initial abduction test, and lift off test. Discriminant analysis was carried out to distinguish 3 types of tear from these 24 values. We surgically diagnosed 11 shoulders with AST, 15 shoulders with BST, and 63 shoulders with FTT. Discriminant analysis successfully distinguished three groups [F(24.150)=2.741, >1.91]. The crepitus (partial F=6.5123) and initial abduction test (partial F=3.6880) contributed significantly to the discrimination. This study showed the possibility that we could distinguish the types of tear in a rotator cuff from a suitable choices of clinical findings.

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【背景】少年期から青年期のスポーツには成長期の傷害が発生する.【目的】高校球児の障害発生予測因子の解明を目的とした.【対象と方法】群馬県高校野球連盟に登録された投手122名を対象にメデイカルチェックを行い, 疼痛の発生に関係する因子を解析した.【結果】肩関節の可動域は投球側で有意に内旋角度が減り, 外旋角度が拡大していた.疼痛を訴えた球児は28名, 23.0%であった.疼痛の発生に有意に関連を有したものは, 球速, 烏口突起の圧痛, 肩インピンジメント徴候, 肩上方関節唇損傷検査項目であり, 肩関節不安定症の検査には影響を受けなかった.X線検査には痛みに関連した異常は見られなかった.【結語】高校球児の投手の疼痛には肩インピンジメント症候群とSLAP損傷が大きな誘因となっていることが示唆され, これらを示唆する検査の陽性生徒には理学療法の指導が必要であることが示唆された.

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The purpose of this study was to evaluate early functional recovery after arthroscopic rotator cuff repair (ARCR). Forty patients with full-thickness rotator cuff tears underwent ARCR and were followed up for one year postoperatively. There were 17 men and 23 women with a mean age of 66.4 years (range 38 to 84 years). The patients were evaluated in terms of the Japanese Orthopaedic Association (JOA) shoulder score at 3, 6 and 12 months after surgery. The JOA score improved significantly from the third months after surgery. Recovery progressed until 12 months after surgery. The mean preoperative JOA score of 68.8 points had improved to 95.4 points by the time of the latest follow-up. The pain score showed a progression curve similar to that of the total JOA score. The function score was improved after 6 months. The range of motion was improved after 6 months for active forward flexion, and only after 12 months for both internal and external rotation. In this series, ARCR gave good clinical results at 12 months after surgery. Rapid pain reduction after ARCR with a lower morbidity may contribute to rapid return of function.

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プレシーズンにおいて投手の肩外転筋力の日常的な変動の実態を明らかにするため，大学野球の現場で投手の肩外転筋力を継続的に測定した．肩外転筋力は1日目96±18N，2日目101±16N，3日目103±18N，4日目108±16N，5日目113±17Nだった．1日目と4日目および5日目の間に有意差が認められ（p<0.01），また2日目と5日目の間にも有意差が認められた（p<0.05）．今回の結果は試合期に向けたプレシーズンにみられる投手の肩の特徴とも考えられる．

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To analyze the relationship of cause and effect between the onset of throwing disorders of the shoulder and decreased muscle strength, two studies were conducted at a baseball field. In study 1, shoulder joint muscle strength was measured when pain developed during practice and the relationship between pain onset and muscle strength was investigated. Decreased muscle strength was noted at the time of pain onset in 8.1% of players. Study 2 was a prospective study in which the relationship between changes in shoulder joint muscle strength from the start of pitching at the beginning of the season to one month later when competitive games began, and shoulder pain that appeared at the beginning of competitive games was analyzed. Based on the results, the possibility of shoulder joint muscle strength being a predictive factor for the onset of throwing disorders of the shoulder was investigated. However the pain group had greater muscle strength than the normal group at the beginning of the season. On the baseball field, the players’ throwing motions and joint function change daily, making it difficult to determine the reason for onset of disorders and injuries. These results suggest that onset of pain at the start of competitive games cannot be predicted from muscle strength at the beginning of the season.

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