著者
宮崎 誠司 浜田 一寿 中島 知隆 内山 善康 福田 宏明
出版者
Japan Shoulder Society
雑誌
肩関節 = Shoulder joint (ISSN:09104461)
巻号頁・発行日
vol.22, no.3, pp.371-374, 1998-09-30
参考文献数
9
被引用文献数
1

In order to evaluate the residual disabilities caused by chronic acromioclavicular (A-C) dislocations,14 Judo athletes (7 cases of Grade II and 7 cases of Grade III) injuries were reviewed. Clinical examinations and isokinetic muscle strength of internal/external rotation and of flexion/extension in the supine position were examined. In Grade II, there were no clinical symptoms or differences in isokinetic muscle strength between the involved and uninvolved sides.<BR>In Grade III,4 cases had motion pain and 3 cases felt weakness in Judo practice. In Grade III the A-C joints, the directions of instability were horizontal as well as vertical. Work magnitudes of extension (60 deg/sec) and those of external rotation at 30&deg; abduction (60 and 120 deg/sec)were less in the involved side than those in the uninvolved sides. Isokinetic muscle strength of extension and external rotation at 30&deg; abduction (60 deg/sec) in Grade III was smaller than that in Grade II. Characteristically, the involved side of Grade III cases had less power than the uninvolved side in flexion/extension above the horizontal level. In Grade III, the torn A-C capsular and coracoclavicular ligaments produce more unstable A-C joints than in Grade II.<BR>During an arm elevation above the horizontal level, more than 3/4 of a clavicle rotation occurs and is controlled by the trapezoid ligament. Unstable A-C joint causes an unstable scapula, leading to muscle weakness of the shoulder, especially in flexion/extension above the horizontal level. The current study showed that the Grade III had patterns in the flexion/extension which were different in the involved and uninvolved sides.<BR>This could explain why there is weakness above the horizontal level in Grade III injuries. Therefore, an operation is recommended for Grade III A-C injuries of Judo athletes.
著者
内山 善康 浜田 一寿 中島 知隆 福田 宏明 宮崎 誠司
出版者
Japan Shoulder Society
雑誌
肩関節 = Shoulder joint (ISSN:09104461)
巻号頁・発行日
vol.22, no.3, pp.537-541, 1998-09-30
参考文献数
10
被引用文献数
6

The purpose of this study was to compare the limitations between the external rotation (ER) of athletes in overhand sports players (OS) and judo players (JP) with traumatic anterior shoulder instability after a modified inferior capsular shift (MICS)procedure. Thiryt-two shoulders of OS and 38 shoulders of JP were operated on using MICS and were observed for more than 12 months postoperatively.<BR>Twenty-six dominant and 6 nondominant shoulders were examined directly. There were 21 &ldquo;tsurite&rdquo; (lapel grip) and 17 &ldquo;hikite&rdquo; (sleeve grip) shoulders in JP. The average ages at surgery of OS and JP were 22.9 and 21.5 years old, respectively.<BR>All the patients had had an episoders of sports injury. There were no recurrences in OS, but 3 (8%)in JP. In OS,12% of the dominant shoulders and 67% of the no ndominant sides after MICS could perform better their sports activities than preoperatively. The ratios of JP which showed a better performance were 15% of operated &ldquo;tsurite&rdquo; and 52% of the operated &ldquo;hikite&rdquo; sides. The average decrease of ER motion in dominant shoulders of OS was 18.8&deg;in the hanging position and 14.5&deg;in 90&deg;of abduction. In JP, &ldquo;tsurite&rdquo; sides had 3.3&deg;and 4.8&deg;of limitation on 0&deg;and 90&deg;of abduction, respectively. There was on other limitation of ROM in either OS or JP, postoperatively. Based on comparisons of ER motion between OS and JP showing better sport activity, ER at 90&deg;abduction should be 80&deg;for the dominant side of OS and 85&deg;for the &ldquo;tsurite&rdquo; side of JP in order to get a better performance, postoperatively. Thus, the &ldquo;tsurite&rdquo; side in JP should be treated in the same manner as that of the dominant side of OS.
著者
中島 知隆
出版者
東海大学
雑誌
奨励研究(A)
巻号頁・発行日
1993

肩峰下インピンジメントの腱板、とくにCodmanの定義した‘critical portion'に対する影響を定量的に解析して腱板断裂ないし変性の発生メカニズムについて検討した。明らかな腱板断裂のないインピンジメント徴候を呈した手術症例(9肩、43-75歳、平均59.7歳)を対象とし、腱板付着部より2mm,7mm,12mm(critical portion)および17mm(筋腱移行部)の四点の滑液包側表面にプラスチック製圧力センサを設置した。また、血流測定用白金電極と組織内酸素分圧測定用電極を挿入した18G針を各点の深さ3mmと8mmまで刺入し、肩峰下接触圧分布とともに組織内血流量、酸素分圧を同時にモニタして、上肢の安静下垂時、他動的前方挙上(30〜180゜)および側方外転時(30〜90゜)における各パラメータの変化と相互の関連性を調べた肩峰下接触圧は安静下垂位〜60゜挙上、30゜外転位まで0であり、その後ほぼ直線的に上昇し140゜挙上、80゜外転位にてピークとなった。安静時、腱板表層の血流量は深層のそれに比べて約1.9倍で、両者は肩挙上、外転時に平行して減少し、90゜挙上、55゜外転位で安静時血流量の1/2、130゜挙上、75゜外転位にて0となった。肩峰下の接触圧と腱血流量の変化は密に相関し、付着部より12mmの表層部ではとくにその傾向が著しかった。一方、腱板酸素分圧は筋腱移行部で最高(243mmHg),critical portionで最低(127mmHg)であり、140゜挙上、80゜外転位において安静時の約1/2に低下した。腱板血流量は上肢を140゜挙上した直後に0になるのに対し、腱板酸素分圧の半減には約20分を要した。すなわち、腱板のなかでもcritical portionにおける易損性は肩峰下インピンジメントによる虚血ではなく、比較的長時間にわたる低酸素状態が腱細胞の軟骨化生を促してその弾性を低下させることに起因すると考えられる。今後、腱組織における酸素代謝がいかに腱変性に関与しているか、について実験モデルを作成してin vitroに検証する予定である。