著者

保坂 正人 町田 拓也 山崎 郁哉 下形 光彦 堤本 高宏

出版者

Japan Shoulder Society

雑誌

肩関節 (ISSN:09104461)

巻号頁・発行日

vol.19, no.2, pp.360-363, 1995

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We wish to present a tabulation of the shoulder joint disorders we encountered in the last two years. The degenerative Changes in the rotator cuff which consist of a wide variety of diseases, which we consider important to differentiate.<br>The subjects were 406 outpatients with shoulder joint disorders. In cases of impingement syndrome, elevation disturbance without contracture, impingement signs and the impingement test were used as a diagnostic criteria. Frozen shouldrs were taken into account only in cases with contracture.<br>There were 170 cases (average age of 57.3) of the impingement syndrome. Rotator cuff tears were observed in 23 of the cases resistant to treatment. There were 77 cases (average age of 58.5) with a frozen shoulder. There were 55 cases (average age of 64.2) of rotator cuff tear or 78 cases when the 23 cases were corrected from the impingement syndrome were included. Then there were 36 cases (average age of 55.2) of calcified tendinitis, 10 cases (average age of 49.8) of bicipital tendinitis and 8 cases (average age of 71.5) of osteoarthrosis of the shoulder joint. There were 50 other cases.<br>The findings of a survey on the patients' backgrounds revealed the existence in many cases with the impingement syndrome and the rotator cuff tear to be among farm and blue-collar workers and that of many cases with calcified tendinitis among females.<br>When treating an impingement syndrome and a rotator cuff tear, we limited the patients' work and encouraged rest. Kinetic therapy was the basic therapy for a frozen shoulder. Steroid injections into the subacromial bursa proved efficacious in cases of impingement syndrome. Attention ought to be paid to the advance of degenerative changes in the rotator cuff and the existence of its tears. Conservative therapy was not satisfactory enough for more than half of the cases with a rotator cuff tear, and about one third of all the cases required surgery. Satisfactory results were obtained with steroid injections into the subacromial bursa for calcified tendinitis.

著者

岡村 健司 木村 明彦 福島 直 青木 光広 薄井 正道 石井 清一

出版者

日本肩関節学会

雑誌

肩関節 (ISSN:09104461)

巻号頁・発行日

vol.23, no.3, pp.453-456, 1999-09-30 (Released:2012-11-20)

参考文献数

7

被引用文献数

7

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[Purpose] Recurrent anterior dislocation of the shoulder in elderly patients has seldom been reported, and the pathologic features of this group have not been fully clarified in the literature. The purpose of this study was to report our operative findings and to investigate the etiology of the recurrent anterior dislocation of the shoulder with onset after the age of 50.[Materials and Methods] We retrospectively studied nine patients who were over 50 years old at the time of initial traumatic dislocation and then who had recurrent instability of the shoulder. We evaluated the operative findings as follows: rotator cuff tear, Bankart lesion, anterior capsular injury. One patient was treated with the Putti-platt method and three had inferior capsular shifts. The other five patients were treated with a Bankart repair. In addition to those operations, seven of them were treated with a modified Bristow method.[Results] Rotator cuff tears were seen in 5 patients, and four of them were massive tears with a subscapularis rupture. There was an elongation of the subscapularis in the other patient. Bankart lesions were seen in 5 patients with a bony lesion. The other 4 patients had abnormal lesions of the anterior capsule.[Conclu sion] In elderly patients, destruction of the shoulder anterior stability structure including the sabscapularis should be considered as one of the main causes of recurrent anterior dislocations.

著者

石田 康行 長澤 誠 谷口 昇 帖佐 悦男

出版者

日本肩関節学会

雑誌

肩関節 (ISSN:09104461)

巻号頁・発行日

vol.42, no.2, pp.474-477, 2018 (Released:2018-09-03)

参考文献数

10

被引用文献数

1

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高齢者の腱板断裂に伴う偽性麻痺肩に対して,RSAを推奨する報告がある.今回70歳以上,自動挙上90度未満の腱板断裂例に対する鏡視下手術の成績を調査した.術後12ヶ月以上観察できた32肩を対象とした.年齢は平均73.9歳,観察期間は平均25.1ヶ月であった.手術法は一次修復術27肩,部分修復術3肩,パッチ法2肩であった.一次修復例の腱板修復状態を術後1年時MRIで調査し,菅谷分類別の術前後のJOAスコア,自動挙上角度(aAE)を調査した.部分修復術,パッチ法のJOAスコア,aAEも調査した.腱板修復状態はtype1,15肩,type3,1肩,type4,4肩,type5,7肩であった.JOAスコア,aAEは概ね改善していたがtype5とパッチ法が他より劣っていた.部分修復術は良好であった.RSAは最終手術である認識が必要である.低侵襲な鏡視下手術は有効で,今後さらに見直されるべきものと考える.

著者

宮崎 義雄 米田 稔 瀧内 敏朗 前田 朗 横田 淳司

出版者

日本肩関節学会

雑誌

肩関節 (ISSN:09104461)

巻号頁・発行日

vol.23, no.2, pp.309-312, 1999-07-30 (Released:2012-11-20)

参考文献数

6

被引用文献数

1

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[Purpose] To clarify the diagnostic value of load and shift test (LST) for the assessment of glenohemeral joint laxity compared with examination under anesthesia (EUA).[Material and Method] We retrospectively reviewed the healthy-side shoulders of 100 patients (65males,35 females) who underwent surgical treatment of their opposite side. Their mean age was 27.5years. We examined the anterior and posterior laxity at 30° and 90° of abduction, and inferior laxity in neutral rotation with the arm at the side. The anterior or posterior laxity was graded into three degrees (-, +, + +), and the inferior laxity was graded into two degrees (sulcus sign -, +). We detrmined the joint laxity positive when the laxity was graded + or + +. We calculated the sensitivity, the specificity and the accuracy of the LST based on the results of the EUA. In addition, when a joint laxity existed at the anterior and posterior transelation on LST, we assessed the discrimination of the grade of the laxity on LST based on the results of the EUA.[Results]Sensitivity, specificity and accuracy of LST were as follows: inferior; 50.0%,96.0%,98.0%, anterior at 30°of abduction; 45.0%,96.3%,86.0%, anterior at 90°of abduction; 54.2%,100%,78.0%, posterior at 30°of abduction; 36.4%,92.9%,68.0%, posterior at 90°of abduction; 56.0%,88.9%,71.0%, respectively. The discrimination of the grade of laxity: anterior at 30°of abduction; 100%, anterior at 90°of abduction; 84.6%, posterior at 30° of abduction; 87.5%, posterior at 90°of abduction; 77.4%.[Conclusion]LST was not sensitive but a specific examination compaired with EUA fbr shoulder joint laxity. Moreover, LST was excellent for the discriminating the gradeof the laxity.

著者

伊奈 沙織 二村 昭元 若林 良明 中川 照彦 宗田 大

出版者

日本肩関節学会

雑誌

肩関節 (ISSN:09104461)

巻号頁・発行日

vol.36, no.3, pp.1099-1102, 2012 (Released:2012-10-25)

参考文献数

10

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We experienced an extremely rare case of thoracic outlet syndrome (TOS) caused by fatigue fracture of the first rib. Case: A 25-year-old male, semi-professional volleyball player, he complained of numbness and weakness of the left upper extremity. Eden-Test, Morley-Test, and Wright-Test were positive on the left. X-ray showed bilateral first rib fractures (non-union on the left side), which was likely caused by heavy muscle training. 3D-CT suggested that the dynamic movement of the pseudoarthrosis following the fatigue fracture was developing incomplete brachial plexus palsy.We performed a surgical decompression by supraclavicular approach without clavicle osteotomy. Compression of the brachial plexus by the dynamic movement of the non-union site was observed. We resected the rib apporoximately 3cm in total.His symptoms had resolved completely after the operation, and he has no problems in playing volleyball.Only a few cases of TOS due to the first rib fracture that has been treated surgically, have been reported. It usually involves the lower trunk of brachial plexus, as we presented. Roos approach and supraclavicular approach are known for TOS operation. Clavicle osteotomy is usually required in the latter approach; however, the procedure seemed invasive for top athletes. Therefore, we chose a supraclavicular approach without clavicle osteotomy in this case. Through this approach, we could obtain a sufficient surgical field to decompress the brachial plexus. In conclusion, we experienced a rare case of TOS caused by non-union after fatigue fracture of the first rib in a volleyball player. Surgical treatment led to complete resolution of the symptoms.

著者

皆川 洋至 井樋 栄二 佐藤 毅 今野 則和 本郷 道生 佐藤 光三

出版者

日本肩関節学会

雑誌

肩関節 (ISSN:09104461)

巻号頁・発行日

vol.20, no.1, pp.103-109, 1996-10-15 (Released:2012-11-20)

参考文献数

14

被引用文献数

3

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Each muscle of the rotator cuff is known to have several intramuscular tendons which provide attachment to numerous muscle fiders. The anatomical relationship between intramuscular and extramuscular tendons needs to be determined to know the distribution of the force to the rotator cuff tendon. The purpose of this study was to clarify the morphology of the transitional zone of intramuscular to extramuscular tendons of the rotator cuff.The muscle fibers of cuff muscles of 20 embalmed shoulders without full-thickness rotator cuff tears were removed to examine the transitional zone of the intramuscular to extramuscular tendons macroscopically. Histological sections of the musculotendinous junction were perpared to evaluate the transitional forms microscopically.We defined the intramuscular tendon as the tendon inside the muscle belly and the extramuscular tendon as the tendon outside the muscle. The extramuscular tendons from the rotator cuff tendon distally. Location was expressed as the % position of the anterior and posterior margins of the musculotendinous junction. The intramuscular tendons of the infraspinatus, teres minor, and subscapularis were contiguous to the whole extramuscular tendons and that the supraspinatus was located in the anterior one-third of the extramuscular tendon(0±0% to 28±15%). Microscopically, the intramuscular tendon of the supraspinatus formed a tendon fiber bundle and was continuous with the second of five layers of the extramuscular tendon (Clark and Harryman,1992).Conclusion: The connection of intramuscular tendon to extramuscular tendon was specific to each cuff muscle. The intramuscular tendon of the supraspinatus was attached to the anterior one-third of the extramuscular tendon and was contiguous to the second layer.

著者

河合 伸昭 菅谷 啓之 高橋 憲正 戸野塚 久紘 中島 亮 寺谷 威 真鍋 博規 安藤 晃 森石 丈二

出版者

日本肩関節学会

雑誌

肩関節 (ISSN:09104461)

巻号頁・発行日

vol.35, no.3, pp.903-906, 2011 (Released:2011-12-21)

参考文献数

14

被引用文献数

2

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Primary frozen shoulder is believed to be a self-limited disease. However, many patients complain of prolonged symptoms such as night pain and refractory stiffness. The purpose of this study is to estimate the efficacy of steroid injection to the glenohumeral joint for primary stiff shoulder associated with night pain. Subjects consisted of 115 consecutive patients, including 37 males and 72 females with an average age of 59.4 years old, who were diagnosed as having primary frozen shoulder at the shoulder clinic in our institute from May to November, 2009. Our treatment principles are as follows: we recommend patients who complain of night pain to keep their arm at rest and carry out trunk and scapular exercises, in addition to steroid injection to the glenohumeral joint once a week until the night pain subsides. Then, physiotherapy is initiated of the hand of therapists. Range of motion at the first visit and at the time when the night pain disappeared was evaluated, as well as that at the final follow-up which was 5.8 months on average.The mean forward flexion, external and internal rotation significantly improved when the night pain disappeared, which was 4.8 weeks on average, from 97.5, 9.2°, and S level to 117.5, 17.4°, and L4 level. The range of motion at the final follow-up was 144 degrees in flexion, 31 in external rotation, and L2 level in internal rotation.Steroid injection to the glenohumeral joint was effective for pain relief for patients with primary frozen shoulder associated with night pain. Removing inflammation at the glenohumeral joint is a key factor when treating such patients and this also enables patients to proceed with effective physiotherapy.

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

浜田 純一郎 山口 光國 筒井 廣明 前田 健 近 良明

出版者

日本肩関節学会

雑誌

肩関節 (ISSN:09104461)

巻号頁・発行日

vol.36, no.2, pp.725-729, 2012 (Released:2012-10-25)

参考文献数

6

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Background: The understanding of the glenohumeral (GH) joint motion during baseball pitching should be necessary for diagnosis and treatment for throwing shoulder. The purposes of this study were firstly to investigate the motions of the scapula, pelvis, upper body, and upper limbs and secondly to speculate the motion of the GH joint and the scapula from the top position to ball release.Methods: We observed the pitching of 2 professional and 2 high-level amateurs with a digital camera and a video camera, recording each motion of the pelvis, upper body, scapula, and upper limbs. We classified pitching motion into 3 phases which were slide, upper body rotation, and arm throwing in order to simply analyze the motion in each phase.Results: Each scapula protracted and retracted respectively during pitching motion. The pelvis which was closed in the stride, ball release, and follow-through synchronized with scapular motion. The throwing arm moved in the scapular plane and made the elbow extend to the ball release. Internal rotation of the humeral head was a little from the top position to the ball release.Discussion: Both scapula and pelvis synchronized at each phase of pitching motion. The motion of the GH joint was speculated to be a small amount from the top position to ball release.

著者

村田 亮 黒田 重史 石毛 徳之 荻野 修平 三笠 元彦

出版者

日本肩関節学会

雑誌

肩関節 (ISSN:09104461)

巻号頁・発行日

vol.36, no.3, pp.1015-1018, 2012 (Released:2012-10-25)

参考文献数

11

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Background: The scapula rotates upwardly during shoulder elevation. If the rotation center wasn't fixed on the scapula but on the humeral head, the movement of the glenoid would be regarded as the rotation along the humeral head. We have analyzed throwing shoulder injury cases using this concept of “functional glenoid”.Methods: Patients with throwing shoulder injury (TSI group; n=22) and normal control (n=8) were included in the study. Two radiographs were taken of each subject (anteroposterior in internal rotation; IR1, zero position). Two straight lines were drawn from the superior and inferior tubercle to the center of the humeral head in IR1 image, and the angle of the lines was measured (α angle). The TSI group was divided to two groups according to slipping of the humeral head in zero position images. The difference of the glenoid inclination angles between IR1 and zero position (β angle) were then measured, and the glenoid extension ratio (α+β/α) was calculated. Each set of data was statistically evaluated.Results: In the TSI group, β angle and the glenoid extension ratio did not show significant difference compared to the control group, but the slipping-negative cases showed significantly larger β angle than slipping-positive cases and the control group.Discussion: These results may be derived from multifactorial pathology of throwing shoulder injury. Significantly large β angle in slipping-negative TSI cases may indicate an adaptive pattern of movement of the scapula. The glenoid extension ratio could not reflect the scapular kinematic change of throwing shoulder injury.

著者

橋本 卓 金谷 整亮 池田 均 塚西 茂昭 信原 克哉 田中 道夫

出版者

日本肩関節学会

雑誌

肩関節 (ISSN:09104461)

巻号頁・発行日

vol.14, no.2, pp.245-248, 1990-09-01 (Released:2012-11-20)

参考文献数

4

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We have measured the intra-articular pressure simultaneously with arthrography of the shoulder. In this study, changes in the intra-articular pressure were examined in unstable shoudlers associated with loose shoulder, rotator interval lesion, and traumatic recurrent anterior dislocaiton.Of the 731 shoulders (731 patients) in which intra-articular pressure was me a sured from 1981, the measurement was possible in 254 shoulders (254 patients). A total of 91 shoulders, consisting of 20shoulders with traumatic recurrent anterior dislocation,40 loose shoulders, and 31 shoulders with rotator interval lesion, were evaluated.Physiologic saline was in f used into the joint, and canges in the intra-articular pressure were recorded as electric signals through a transducer. The arm was moved up and down passively, and the pressure was measured at intervals of 10.In loose shoulder and rotator interval l e sion, the intra-articular pressure decreased as the arm was lifted higher, but the decreases were smaller than in normal shoulders. In these groups, there was a smaller pressure increase to the position of maximum uplift with a smaller peak value and within a narrower range than in the normal group. These findings were more notable in the shoulders with an FSH angle of 81' or greater. These results suggest that the intra-articular pressure reflects the joint capacity.In traumatic recurrent anterior dislocation, however, the decrease in the pressure in an early stage of arm lifting was the greatest among all groups including the normal group, and the pressure increase with arm lifting was gentler in shoulders with an FSH of 80 °or less, unlike in the other two groups.The changes in the intra-articular pressure in shoulders with traumatic recurrent anterior dislocation may be explained by disruption of the anterior capsular mechanism and muscle contraction due to anxiety over the possibility of dislocaiton during arm lifting as well as the looseness of the articular capsule.

著者

小松田 辰郎 佐藤 克巳 成重 崇 熊谷 純 石橋 弘二

出版者

日本肩関節学会

雑誌

肩関節 (ISSN:09104461)

巻号頁・発行日

vol.25, no.2, pp.305-308, 2001-08-02 (Released:2012-11-20)

参考文献数

8

被引用文献数

2

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[Purpose]The present study was undertaken to elucidate the pathological conditions of both the capsule and subacromial bursa of contracted shoulders associated with rotator cuff tears.[Materials and methods]Twenty-six shoulders of 26 patients,22 males and 4 females, aged from 37to 75 years old (mean 57) received brisement procedures prior to cuff surgeries. There were 8 large,12 small and 6 partial thickness tears. Arthroscopic observation was done to find out the site of the capsular injury after the brisement procedures. Macroscopic observation of torn cuffs and the adhesion of the bursa were also performed.[Results]Arthroscopic findings after brisement procedures revealed redness, proliferations, and bleeding of the synovium in the glenohumeral joint. There were two types of capsular injuries. TypeA: tear of the axillar region(17 shoulders), Type B: tear of the axillar and rotator interval regions(9 shoulders). The number of cases of (Type A: Type B) was (7: 1) with large tears, (6: 6) with small tears and (4: 2) with partial thickness tears. If cuff tears included the rupture of the anterior band of the supraspinatus tendon, the number of (Type A: Type B) was (12: 3), while it was (1: 4) without a rupture of the band. Although there were adhesions between the bursa and cuff in 85% shoulders, no disruptions were found in the subacromial bursae.[Conclusion]The main cause of a shoulder contracture assosiated with rotator cuff tears was located at the axillar and rotator interval capsules and was influenced by the size of the location and cuff tears.

著者

岩堀 裕介 加藤 真 佐藤 啓二 花村 浩克

出版者

日本肩関節学会

雑誌

肩関節 (ISSN:09104461)

巻号頁・発行日

vol.27, no.2, pp.415-419, 2003-08-20 (Released:2012-11-20)

参考文献数

18

被引用文献数

9

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We measured the range of internal and external rotation of the shoulders and evaluated the effect of shoulder stretching in little league baseball players. Physical examinations were performed on fifty-two little league baseball players (range of age, nine to twelve years old), and measurements of the range of shoulder rotation were made with the patients supine and the shoulder at 90° abduction. Twenty-nine players, themselves and their partners were shown how to shoulder stretch and the effect of the stretching was evaluated. They demonstrated a significantly increased external rotation and a significantly decreased internal rotation range of motion compared with the opposite shoulders. The significant differences were found in all ages. Self stretching showed the least effect, while significant increased internal rotation was obtained by partner stretching. We found a significant loss of internal rotation of the throwing shoulders even in little league baseball players. Partner stretching was useful for recovery of the motion loss.

著者

森石 丈二 黒田 重史 住吉 徹是 斎井 政憲 李 鐘勲

出版者

日本肩関節学会

雑誌

肩関節 (ISSN:09104461)

巻号頁・発行日

vol.15, no.2, pp.338-341, 1991-09-01 (Released:2012-11-20)

参考文献数

15

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Two cases of infraspinatus muscle atrophy in athletes were treated operatively. [case 1] A 21 year-old left-handed volleyball male player.We performed a two stage-operation on his left shoulder. At first we released the suprascapular nerve ( resection of the superior transverse scapular ligament, neurolysis and partial shaving of the base of the spinoglenoid ) and two months later, we performed a repair of the rotator interval.[case 2] A 17 year-old right-handed student pictcher.We perfomed decompression of the suprascap u lar nerve in the same way as in case 1.In all the operations, we found the supascapular nerve was swollen and inflamed at t h e region between the suprascapular and the spinoglenoid notch. In case 1, he was free of pain and able to resume of pitching successfully after surgery. In case 2 however, he got little relief of pain and was still weak. In his case, not only did he have suprascapular neuropathy but also disorders of the infraspinatus muscle.

著者

森澤 豊 川上 照彦 山本 博司 貞広 哲郎

出版者

日本肩関節学会

雑誌

肩関節 (ISSN:09104461)

巻号頁・発行日

vol.20, no.1, pp.117-121, 1996-10-15 (Released:2012-11-20)

参考文献数

6

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The pathogenesis of a rotator cuff lesion of the shoulder is still controversial.The authors investigated the mechanoreceptors in the rotator cuff, the subacromial bursa and the coracoacromial ligament in order to clarify the proprioception of the shoulderjoint.

著者

林田 賢治 中川 滋人

出版者

日本肩関節学会

雑誌

肩関節 (ISSN:09104461)

巻号頁・発行日

vol.29, no.3, pp.651-654, 2005-08-10 (Released:2012-11-20)

参考文献数

9

被引用文献数

4

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The aim of this study was to elucidate the relationbetween internal (IR) and external rotations (ER) strength of the shoulder and shoulder pain during throwing in high school baseball pitchers. Internal and external rotation strength of the shoulder were measured in 401 high school pitchers, who had attended the national inter high school baseball tournament in Japan, and the influence of internal and external rotation strength of shoulder on shoulder pain during the throwing were assessed. The average IR and ER strength were 105.3+/-32.2N and 93.1+/-28.3N. The average IR. ER, and ER/IR ratio were 1.18+/-0.22,0.98+/-0.14, and 0.92+/-027, respectively, in all pitchers. All pitchers were classified into two groups. The pain experienced group (P group), which involved the pitchers who had experienced shoulder pain during throwing prolonged more than one month within the year, included 40 pitchers, and the other group (NP group) included 361 pitchers. The IR, ER, IR ratio, ER ratio, and ER/IR ratio were compared between both groups. The ER/IR ratio of the P group was lower than that of the NP group, with a statisticaldifference by unpaired student t-test (p=0.02). Pitchers with a low ER/IR ratio tend to injure their throwing shoulder and proper ER/IR ratio could be one of important condition for throwing shoulders.

著者

堀 克弘 吉川 玄逸 平岡 誠司 松末 吉隆 村上 元庸

出版者

日本肩関節学会

雑誌

肩関節 (ISSN:09104461)

巻号頁・発行日

vol.27, no.3, pp.455-458, 2003-10-30 (Released:2012-11-20)

参考文献数

7

被引用文献数

1

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A rupture of the rotator cuff tendon may induce muscular fatty degeneration, which can be observed with computed tomography (CT) imaging. The purpose of this study was to examine the frequency of fatty degeneration in patients with a complete rotator cuff tear using CT images.Twenty shoulders in twenty eight patients (average age sixty point seven years old ) with a complete cuff tear were studied. Fatty degeneration was evaluated using CT images and assessed by Goutallier's classification. The diagnosis of rotator cuff tear was made by the examiner, after which the frequency of fatty degeneration was determined. Supraspinatus tendon ruptures were found in eleven patients, infraspinatus tendon ruptures in two, supraspinatus and infraspinatus tendon ruptures in six, supraspinatus and subscapularis tendon ruptures in eight, and all three tendons were found ruptured in three. The frequency of fatty degeneration in the infraspinatus tendon was 66.7%, while that in the supraspinatus and subscapularis tendons was 35.7% and 23.1%, respectively. Some reports have concluded that postoperative results for rotator cuff repair are inferior when fatty degeneration has occurred, thus, it is best if surgery can be performed prior to its appearance. From the results of the present study, we considered that fatty degeneration is more prevalent with the infraspinatus tendon. Therefore, when a rupture of the this tendon is suspected, an operation should be carried out as soon as possible.

著者

北村 歳男 高木 克公 山鹿 眞紀夫 森澤 佳三 井手 淳二 荒木 崇一 田上 学

出版者

日本肩関節学会

雑誌

肩関節 (ISSN:09104461)

巻号頁・発行日

vol.18, no.1, pp.1-4, 1994-09-01 (Released:2012-11-20)

参考文献数

8

被引用文献数

1

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The purpose of this research was to clarify the causes of numbness and pain by traction of the upper limbs. We stretched the nerves in the upper limbs of rats by utilizing the flail of the shoulder girdle, and measured the blood flow of the brachial plexus and the median nerve. The model animals,32 wistar rats, were inserted with steel lines to the radius and ulna. These steel lines were drawn in the direction of a shoulder abduction of 80 degrees. A decrease and recovery of the blood flow were measured using the hydrogen gas clearance method.The blood flow of the subepineural space in the brachial plexus decreases sharply in conditions with looseness of the plexus.The blood flow of the intrafuniculuse in the brachial plexus decreases like a straight line in those states without looseness of the plexus. The blood flow of the subepineural space in the median nerve decrease like a straight line, too. The decrease rate of the subepineural space was sharper than that of the intrafuniculuse. As for the recovery rate, there was no significant difference in either site.One of the factor that causes nervous and functional imbalance with a slight traction is a sharp reduction of the blood flow in the subepineural space of the brachial plexus.

著者

村上 元庸 小島 保二 前田 敏博 牧川 方昭 福田 眞輔

出版者

Japan Shoulder Society

雑誌

肩関節 (ISSN:09104461)

巻号頁・発行日

vol.15, no.1, pp.4-8, 1991

被引用文献数

2

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Sensory nerve endings in the monkey shoulder joint capsule were observed by light microscopy. The nerve staining technique was based upon Tago's method which was very sensitive for acetylcholinesterase (Ach E) existing in the peripheral nerve.<BR>Three distinct sensory nerve endings have b een identified: free nerve endings, Ruffini-type corpuscles, and Pacini-type corpuscles.<BR>Ruffini-typc corpuscles a n d Pacini-type corpuscles, which were thought to act as mechanoreceptors, were mainly localized in the transitional portion between the labrum and the capsule, but not within the labrum.<BR>Free ne r ve endiings, which may function as nociceptors (Pain), were distributed widely in the capsule and also in th labrum.<BR>As the results demo n strated that may mechanoreceptors exist in the capsule, it is presumed that the capsule acts not only as a static stabilizer, but also as a sensory apparatus for stress, and plays an important role in the dynamic stabilizing system. It seems that the location of the mcchanoreceptors is the optimum place for sensors to respond to the resultant force which dislocates the humeral head.<BR>Finally, we hypothesize that the dynamic stabilizing effect is performed by a series of reflex effects from the capsule to the surrounding muscle of the shoulder.

著者

筒井 廣明 山本 龍二 安楽 岩嗣 三原 研一 今里 有紀彦 保刈 成

出版者

Japan Shoulder Society

雑誌

肩関節 (ISSN:09104461)

巻号頁・発行日

vol.15, no.1, pp.13-17, 1991

被引用文献数

3

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The shoulder joint is the most mobile joint in the body combined with a small glenoid and a large humeral head. This joint has been thought to be an unstable joint because of its anatomical structure and the recurrence rate from initial dislocations. Our opinion of this joint is that it has most distinguished stabilizing mechanisms for keeping a wide range of motion.<BR>1. The first stabilizing mechanism<BR>This mechanism is the bony combination of the radius between the glenoid cavity and the humeral head. The anatomical study showed the radius of a cross section of the glenoid was 16.8 mm and of the humeral head 22 mm. The computation of the maximum permissible kinetic vector that enables the humeral head to be on the glenoid was 43&deg;.<BR>2. The second stabilizing mechanism<BR>The second mechanism is the function of the anterior capsule including the inferior glenohumeral ligament.<BR>The anterior capsule works involuntary in both its tension and direction as the centripetal force does against the shear force.<BR>3. The disadvantages of these two stabilizing mechanisms<BR>The disadvantages of these two stabilizing mechanisms are; - Inefficiency against the increased anterior kinetic vector during the positioning of the upper extremities vertically against the glenoid<BR>- The decrease of bony structural intensity compared with other joints such as the hip joint.<BR>4. The third stabilizing mechanism<BR>The third stabildzing mechanism is the function of the shoulder girdle.<BR>Its first function is the mobility of the scapula working as shock ab s orber against the share force that falls on the glenohumeral joint.<BR>The second is the function of the shoulder girdle muscles such as the pectoralis major and the deltoid.<BR>In conclusion, therefore, a normal shoulder joint should be the most distinguished joint with these stabilizing mechanisms physically and anatomically maintaining a wide range of motion.