著者

宮沢 知修 松井 健郎 小川 清久

出版者

日本肩関節学会

雑誌

肩関節 (ISSN:09104461)

巻号頁・発行日

vol.13, no.2, pp.247-251, 1989-11-01 (Released:2012-11-20)

参考文献数

5

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Objective: It has been reported that the acromiohumeral interval (hereafter referred to as AHI) narrows in rotator cuff tears (RCT). In many cases, however, it does not. In this study we re-examined the clinical significance of the AHI.Subjects and method: AHI was studied in the f ollowing: normal shoulders, as the control group,55 cases,55 shoulders; RCT (massive: 45·46; complete: 62·64; partial: 51·52), periarthritis: 57·66, and unstable shoulder: 63·85. The AHI was measured as the distance between the humeral head and the under surface of the acromion in a standingposition A-P view (internal and external rotations and neutral position) and scapular Yview.Results: In normal shoulders the internal rotation AHI was the widest, at 8-16 mm (average 11.3 mm), indicating a significant difference from other roentgenographic directions and measurement values. Concerning the neutal-position measurements in normal shoulders and each disease condition, the AHI was 3-12 mm (average 6.9 mm) for the massive tear group, and this represented the most narrowing found and was significantly different from all of the other groups measured.Conclusion:1) The AH I in normal shoulders expands with internal rotation and narrows with external rotation.2) In AHI measurements, important considerations are consistency of the positioning and the angle of roentgenography, and the most appropriate view is the neutral position.3) With a roentgenographic method in standing-position, the AHI measu r e ment is clinically significant only in diagnosing a massive RCT.4) As a diagnostic standard for a massive RCT, an AHI of 6 mm or less is appropriate, but allowances should be made for 52% of false negatives and approximately 18% of false positives.

著者

小川 清久 皆川 邦直 松井 健郎

出版者

日本肩関節学会

雑誌

肩関節 (ISSN:09104461)

巻号頁・発行日

vol.12, no.1, pp.95-100, 1988-08-10 (Released:2012-11-20)

参考文献数

2

被引用文献数

1

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Psychological factors have seemed to play an important role in voluntary shoulder dislocation. Nevertheless, there are no detailed reports of those who have received psychiatric treatment. We would now like to report the following 4 cases whose shoulder dislocations were caused as a manifestation of psychological factors.Case 1: 28 y. o., female. When the patient was about 16 years old, she dislocated both shoulders by minimal trauma; then, voluntary shoulder dislocation developed. She underwent five operations at a certain hospital from the age of seventeen. As the dislocation had recurred within 6 months postoperatively on each occasion, she visited our clinic. As we recognized split object relations, we told her to have a psychiatric examination. As a result, it became clear that she had a borderline personality disorder and the dislocation was a trend of autoclasia.Case 2: 22 y. o., female. This case is the similar disorder to Case 1, but, just a slight.Case 3: 15 y. o., female. Voluntary shoulder dislocation and pain appeared in her left shoulder two years ago. As her relations with her mother were unnatural, we recommended a psychiatric examination. The result clarified that an adjustment disorder during adolescence existed.Case 4: 23 y. o., female. Two years ago she suffered from traumatic dislocation caused by a traffic accident, and lost her fiance. Then, after she started going out with another man, dislocation of the shoulder began to occur at twilight accompanied by a syncope-like episode. Though it was spontaneously repositioned under general anesthesia, the dislocation occurred again when she came out from under the anesthesia. Therefore, we requested the cooperation of the psychiatric dept.. As a result, she was diagnosed as having hysterical neurosis.