著者

建道 寿教 橋本 淳 橋本 卓 駒井 正彦 中村 真里 信原 克哉 中村 康雄

出版者

Japan Shoulder Society

雑誌

肩関節 (ISSN:09104461)

巻号頁・発行日

vol.28, no.3, pp.427-431, 2004

被引用文献数

2

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The Purpose of this study was to analyze the articular contact pattern of the normal glenohumeral joint. There are few previous papers concerning the dynamic contact patterns, although the studies of using the cadaver or the tracking device have been reported. The subjects consisted of 10 normal volunteers. The subjects were fixed on a tilted stand with free motion around the scapula.3D MRI images were extracted at the scapular plane at every 30° between 30° and 150° in the supine position. The images obtained at each position were transmitted to a personal computer and the description of the bony frame by digitizing methods using the analyzing software were developed. Three dimensional reconstruction of the glenohumeral joint were performed. The items of measurement were the following (1)The contact area; the distances between the humeral head and the glenoid surface were calculated and the distribution set at the distances were considered to be the contact area. The shortest distance was regarded as the proximity of the joint. The change of the center of the distribution was investigated. (2)The center of the humeral head (3) Kinematics of the humerus; (from the aspect of the scapula) Results: (1)In the contact area; the minimum contact area had shifted superiorly up to 90 or 120° elevation, but after 120° it shifted inferiorly. Concerning the antero-posterior direction of the glenoid, it shifted antero-inferiorly at the elevated position compared to that of the 30Thlevation. (2)In the center of the humeral head; it shifted superiorly at 120° or 150° compaired to the 30° elevation. Its change was within 3mm. (3)In the Kinematics of the humerus; although the glenohumeral movement was totally 66°, it was only 17' after 90° elevation. We conclude that although the contact area shifted superior until 90°, it shifted to the central part of the glenoid over 120°, because the centripetal force might have worked at the elevated position. The distribution of the contact area was assumed to be reflected as a result of seeking a good congruity of the humeral head and the glenoid.

著者

青木 光広

出版者

Japan Shoulder Society

雑誌

肩関節 (ISSN:09104461)

巻号頁・発行日

vol.29, no.3, pp.621-624, 2005

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Periarthritis of the shoulder is characterized by freezing phase, frozen phase, and thawing phase. However, the pathology of its clinical course is not clarified. Recent development of shoulder open surgery, arthroscopy, MRI and PET demonstrated that shoulders with persisting pain and contracture had hyperemia and edema of the joint capsule and subacromial bursa. Thus, we tried to elucidate clinical phases of frozen shoulder based on connective tissue repair and remodeling.<br>Early freezing phase of the shoulder is consistent with acute inflammatory phase of connective tissue repair. In this period, edema and hyperemia of the shoulder joint capsule appears with occurrence of shoulder pain (0 to 1 month from the onset). Late freezing phase of the shoulder is consistent with fibroplasias of connective tissue repair. In this period, infiltration of fibroblasts and new vessels in the capsule appears with progressive pain and reduction of range of motion (1 to 2 months from the onset). Freezing phase of the shoulder is consistent with consolidation stage of remodeling of connective tissue repair. In this period, fibrosis and thickening of the joint capsule appears with progressive contracture (2 to 6 months from the onset). Thawing phase of the shoulder is consistent with maturation stage of remodeling of connective tissue repair. In this period, remodeling of joint capsule appears with gradual relief from joint contracture (6 month to 1 year from the onset).<br>Joint capsule of the shoulder is known to have enough redundancy. However, if the inflammation of the capsule spreads all over the shoulder joint, fibrosis and production of collagen fibers in the capsule develops. Subsequent relief form joint contracture with remodeling of the capsule explains characteristic features of clinical staging of periarthritis of the shoulder. Comparing clinical stage and extent of connective tissue repair, theoretical back ground of physical therapy and surgical treatment is evident.

著者

小竹 俊郎 山川 知之 岡本 幸大

出版者

Japan Shoulder Society

雑誌

肩関節 (ISSN:09104461)

巻号頁・発行日

vol.29, no.3, pp.629-632, 2005

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The purpose of this study was to evaluate 4 patients with marked atrophy of the shoulder girdle muscles caused by degenerative processes of cervical spine.4 patients presented themselves with deltoid paresis with the absence of sensory deficits or myelopathy. The patients were 3 males and one female. Their age at treatment was from 49 to 74 years-old with an average of 61.7 years old. Their mean follow-up period was 17months (17-29).3 cases underwent a cervical anterior decompression and one case was treated conservatively. The severity of deltoid paralysis was classified into five grades according to the manual motor power test and swallow tail sign. Theclinical outcome of each case was evaluated at pretreatment and at followup with JOA scores. Of 4 patients, three had C4/5 cervical spondylosis and one had C4/5 and C5/6. In the all cases, muscle power had improved significantly from MMT 2 to MMT 5. The JOA scores averaged 65.8 points at pretreatment and 98.8 points at follow-up. It is important for the differential diagnosis of shoulder girdle damage in cervical spondylotic syndrome of rotator cuff tears. The swallow tail sign in diagnosis and treatment was effective for a cervical spondylotic amyotrophy.

著者

前田 和彦 菅谷 啓之 新井 隆三 森石 丈二 望月 智之 吉村 英哉 松木 圭介 秋田 恵一

出版者

日本肩関節学会

雑誌

肩関節 (ISSN:09104461)

巻号頁・発行日

vol.31, no.2, pp.209-211, 2007

被引用文献数

5

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It is generally believed that the supraspinatus tendon plays an important role in the shoulder function. However, precise anatomy of the supraspinatus tendon has not been well described. The purpose of this study was to investigate the anatomy of the supraspinatus tendon. 57 cadavers (103 shoulders) were used for this study. The clavicle and humerus were cut off at their proximal parts. After resection of the acromion, the coracohumeral ligament was carefully removed. In some specimens, the infraspinatus was completely removed from the humerus to observe the overlapping portion of the supraspinatus and infraspinatus. The supraspinatus muscle and its origin were carefully investigated macroscopically. In 4 shoulders, muscle fibers were completely removed to examine the direction and insertion of the supraspinatus tendon in detail. The supraspinatus muscle fibers originated from the spine of the scapula and the supraspinatus fossa, and they were running toward and attached to the thickest tendinous portion, which was located at the anterior part of the supraspinatus muscle. This tendinous portion was strongly attached to the most anterior portion of the greater tuberosity adjacent to the bicipital groove or at the lesser tuberosity (21.3%). Another part of the supraspinatus, which was located posteriorly, was attached to the greater tuberosity adjacent to the articular cartilage as a thin membrane. The insertion of the supraspinatus tendon revealed to be the most anterior portion of the greater tuberosity and the lesser tuberosity. These results suggested that the supraspinatus tendon worked more efficiently as an abductor of the shoulder joint with the arm externally rotated than internal rotation.

著者

吉村 英哉 望月 智之 宗田 大 菅谷 啓之 前田 和彦 秋田 恵一 松木 圭介 中川 照彦

出版者

日本肩関節学会

雑誌

肩関節 (ISSN:09104461)

巻号頁・発行日

vol.31, no.2, pp.217-219, 2007

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Previous studies reported a presumably unusual bony attachment of the pectoralis minor muscle. However, less attention has been given to the insertion of the continuation to the glenohumeral joint. The purpose of this study was to evaluate the frequency of this abnormal insertion of the pectoralis minor muscle, and also to investigate the relation between this continuation and the capsule. 81 anatomic specimen shoulders from 41 cadavers were dissected. The insertion of the pectoralis minor tendon to the glenohumeral joint was carefully investigated. The pectoralis minor tendon ran beyond the coracoid process and extended to the superior portion of the glenohumeral joint in 28 out of 81 specimens (34.6%). The continuing insertion divided the coracoacrominal ligaments into two limbs. The continuation was more variable, and consisted of the whole tendon in 6, the middle part in 5, the lateral part in 15, and the medial part in 2 specimens. Furthermore, the pectoralis minor tendon inserted to the posterosuperior border of the glenoid in 6, to the greater tuberosity in 7, and both to the glenoid and the greater tuberosity in 15 specimens. The prevalence of the anomalous insertion of the pectoralis minor tendon revealed to be as high as 34.6% in the present study. This may suggest that the pectoralis minor tendon plays an important role in the stability of the glenohumeral joint.

著者

落合 信靖 山﨑 博範 佐々木 裕 山口 毅 木島 丈博 松木 圭介 見目 智紀

出版者

日本肩関節学会

雑誌

肩関節 (ISSN:09104461)

巻号頁・発行日

vol.37, no.2, pp.461-463, 2013 (Released:2013-12-10)

参考文献数

9

被引用文献数

1

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Background: Diffusion-weighted imaging (DWI) based on magnetic resonance imaging (MRI) can provide valuable information regarding the microstructure of tissues by monitoring the random movement of water molecules. The diffusion data can be used for determination of quantitative diffusion values such as the apparent diffusion coefficient (ADC). The purpose of this study was to evaluate rotator cuff muscle activity using DWI.Methods: DWI was performed before and after loaded on empty can test and full can test and compared before and after those tests.Results: ADC of supraspinatus, infraspinatus and superior portion of subscapularis were increased after empty can test. ADC of supraspinatus, superior portion of infraspinatus and superior portion of subscapularis were increased after full can test. Anatomical study showed that the infraspinatus had contributed in shoulder abduction in shoulder internal rotation.Discussion: This study showed the agreement with the anatomy of the previous study, an increase of ADC in supraspinatus and infraspinatus in empty can test and an increase of ADC in supraspinatus mainly in full can test. There were possibilities that DWI could evaluate the activity of rotator cuff muscle.

著者

荻本 晋作 鶴田 敏幸

出版者

日本肩関節学会

雑誌

肩関節 (ISSN:09104461)

巻号頁・発行日

vol.40, no.3, pp.1109-1115, 2016 (Released:2017-04-26)

参考文献数

16

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健常成人男性の肩関節周囲筋群の筋電図解析を行い,臨床応用について検討した.棘上筋,棘下筋横走・斜走線維,小円筋にはエコー下にワイヤー電極,上腕二頭筋と三角筋の前・中・後部線維には表面電極を用い,3つの挙上の経路(前方,肩甲骨面,側方),4つの回旋角度(thumb down,palm down,thumb up,palm up),2つの挙上角度(45,90度),2つの負荷(自重,3 kg 重錘)を組み合わせた48通りの筋活動を計測した. 自重負荷では,側方挙上90度での最大内旋位で棘上筋は最大の筋活動となり棘下筋は最小の筋活動を示した.棘下筋は前方挙上90度での最大外旋位で高い筋活動を示すのに対し棘上筋の筋活動は最小となった.同一肢位では上腕骨は外旋するほど三角筋にかかる負担は少ない傾向であった.徒手検査では棘上筋は側方挙上内旋位,棘下筋は前方挙上外旋位でのテストが有用である可能性がある.

著者

山根 慎太郎 吉岡 千佳 大泉 尚美 末永 直樹

出版者

日本肩関節学会

雑誌

肩関節 (ISSN:09104461)

巻号頁・発行日

vol.37, no.3, pp.927-929, 2013 (Released:2013-12-10)

参考文献数

8

被引用文献数

1

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Background: The objective of this study was to analyze the rotator cuff muscles and other 7 muscles activity simultaneously during shoulder abduction by utilizing electromyographic (EMG) analysis.Methods: Measurements were compared between full can and empty can exercise. Non-dominant shoulders of five asymptomatic male volunteers (21-34 y.o.) were investigated. Fine-wire EMG electrodes were inserted into supraspinatus (SSP), infraspinatus (ISP), teres minor (TM), and upper and lower part of subscapularis (SSCU and SSCL). Surface electrode EMG were collected from lattisimus dorsi(LD), deltoid anterior(DA), middle(DM), posterior(DP), pectralis major upper(PMU), lower(PML), and trapezius(TRAP). The EMG data were collected during abduction exercises on the scapula plane while holding 1kg dumbbell. The EMG value was expressed as a percentage of MVC (maximum voluntary contraction) of the corresponding muscle to standardize.Results: %MVC of DM was significantly higher with empty can exercise. DP and TRAP showed a trend that %MVC was higher with empty can exercise (P=0.07,0.08) than with full can exercise. In the cuff muscle, we could not see any statistically significant difference, however, %MVC was higher in the ISP, SSCU, SSCL, TM with empty can exercise. It is reported that contraction of SSP is not different between full and empty can position.Conclusion: In this study, the other cuff muscles (ISP,SSC,TM) showed higher %MVC with empty can exercise. The empty can exercise may be a good exercise to recruit the all cuff muscles.

著者

三幡 輝久 渡辺 千聡 阿部 宗昭 木下 光雄

出版者

日本肩関節学会

雑誌

肩関節 (ISSN:09104461)

巻号頁・発行日

vol.31, no.2, pp.433-436, 2007

被引用文献数

1

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The objective of this study was to assess the effect of shoulder horizontal abduction and external rotation on shoulder internal impingement. Eight cadaveric shoulders were tested using a custom shoulder testing system. Rotator cuff insertion points on the greater tuberosity were recorded using Microscribe digitizer at maximum external rotation position. Glenohumeral contact pressure at the maximum external rotation position was measured using a Fuji Prescale Film. Data were compared between the scapular plane (SP), 15 degrees horizontal abduction from scapular plane (15HA), 30 degrees horizontal abduction from scapular plane (30HA, simulated coronal plane), and 45 degrees horizontal abduction from scapular plane (45HA). The comparisons were also made between intact, after 20% stretching anterior capsule (an increased external rotation), and after an anterior capsular placation (a decreased external rotation). Data were analyzed using Tukey's post hoc test (p<0.05). Rotator cuff insertion points at 30HA and 45HA were located significantly anteriorly compared with those at the scapular plane and 15HA (p<0.01). The total contact pressure and total contact area in posterior glenohumeral joint at 30HA and 45HA were significantly greater than those at the scapular plane and 15HA (p<0.001). After stretching, maximum external rotation was increased and rotator cuff insertion points were significantly posteriorly located compared with intact condition at scapular plane (p<0.05). The cuff insertion points at more than 30 degrees of horizontal abduction were anterior to the posterior edge of glenoid, suggesting that excessive horizontal abduction, which is greater than coronal plane, may result in pathologic shoulder internal impingement.

著者

田崎 篤 二村 昭元 加藤 敦夫 山口 久美子 秋田 恵一 星川 吉光 望月 智之

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.787-790, 2012

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<B>Background:</B> Anatomical information of the insertion of the capsule around the glenoid is essential to recognize the pathological mechanism of shoulder disorders and perform better surgery.<BR><B>Methods:</B> Twenty five shoulders were dissected to investigated the morphology and size of the insertion of the capsule around the glenoid. We treated superior capsule as capsule-CHL. The location of glenoid rim was expressed as the location of the clock face of the glenoid.<BR><B>Results:</B> In the superior margin of the glenoid, the insertion of the capsule-CHL complex covered broadly to the base of the coracoid process in a triangular shape. Belt-like shape insertion was observed in posterior margin of the glenoid. Whereas as you followed anterior to the anteroinferior part, 4-5 oclock was thicker, then gradually thin down toward inferior. The average maximum width of the anterior and posterior insertion was 8.1mm (6.6-10.1mm)and 8.1mm (6.6-10.1mm), respectively. Although the width of insertion tapered, the capsule sent its fibers and connected to the lateral part of the LHT. Its attachment was observed as a thick portion from inside of the joint. This portion was observed as the posterior inferior gulenohumeral ligament.<BR><B>Conclusion:</B> The fact of thick attachment of the capsule on the glenoid rim should be considered when we perform surgery for shoulder instability. Fibrous connection between the capsule and LHT, which compensates for thin capsular attachment at inferior part, reinforces inferior stability. Since contraction of LHT pulls the inferior capsule inferiorly, this mechanism may have a role to avoid impingement of the inferior capsule.

著者

向井 章悟 中川 泰彰 田中 慶尚

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.1037-1040, 2012

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The symptoms of cartilage injury of humeral head are not well known. We experienced two cases of traumatic cartilage injury of humeral head in American football players.<BR>Both cases were young(21 and 20 years old), male college American football players and they were both running backs. The first case complained of motion pain for 1 year since he had fallen on his left shoulder after a tackle. This case showed osteoarthritic change and impression fracture of humeral head. The second case complained of pain and felt a click in abduction-external rotation after a blunt hit on his right shoulder by tackle one week before. The MRI showed Bankart lesion and cartilage injury of humeral head.<BR>In both cases, full thickness cartilage defects of humeral head were observed and these lesions were engaged to the anteroinferior edge of glenoids when the shoulders were abducted and externally rotated. They were treated by arthroscopic Bankart repair and returned to the sports after standard rehabilitation. Now they are relieved of their symptoms.<BR>There are few reports of cartilage injury of humeral head because the diagnosis is difficult without arthroscopy. These two lesions are located in the posterior portion of humeral head, which is different from typical Hill-Sachs lesions. There are cartilage lesions in anterior glenoid in both cases, which may induce the symptoms such as subluxation or click in abducted-external rotated position. These cases reveal that cartilage injury of humeral head is not rare in high-energy injury, especially in collision sports.

著者

設楽 仁 高岸 憲二 下山 大輔 石綿 翔 高澤 英嗣 一ノ瀬 剛 山本 敦史 小林 勉

出版者

日本肩関節学会

雑誌

肩関節 (ISSN:09104461)

巻号頁・発行日

vol.37, no.2, pp.755-759, 2013

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<B>Background:</B> There are many studies about the relationship between brain functional changes and chronic pain such as CRPS, fibromyalgia, osteoarthritis of the knee and chronic back pain.<BR>However there is no study about the relationship between brain functional changes and shoulder disease. The purpose of this study is to clarify the brain functional changes regarding to shoulder pain using functional magnetic resonance image (fMRI) in rotator cuff tear (RCT) patients.<BR><B>Methods:</B> Nine healthy volunteers and 9 RCT patients participated in this study. Brain activation was examined by fMRI technique (3 Tesra-MRI). We applied an active shoulder motion task and a motor imagery task during fMRI.<BR><B>Results:</B> In the active shoulder motion task, there was significant activation in the right premotor cortex, right primary somatosensory cortex, right superior parietal lobule, bilateral prefrontal cortices, right intraparietal sulcus, anterior cingulate cortex, left lingual gyrus and left cerebellum in RCT group compared to normal group.<BR>In the motor imagery task, there were brain activities in the left prefrontal cortex and supplementary motor area which was related to the pain matrix despite the absence of feeling pain in RCT group compared to normal group. <BR><B>Conclusion:</B> The current study reveals that RCT can cause reorganization of the central nervous system, suggesting that such an injury might be regarded as a neurophysiologic dysfunction, not a simple peripheral musculoskeletal injury. This study is the first evidence that the pain with RCT is related to the brain functional change.

著者

中溝 寛之 橋本 淳 中村 真里 金谷 整亮 信原 克哉 中村 康雄

出版者

日本肩関節学会

雑誌

肩関節 (ISSN:09104461)

巻号頁・発行日

vol.28, no.2, pp.355-358, 2004-08-30 (Released:2012-11-20)

参考文献数

5

被引用文献数

1

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The purpose of this study was to investigate the characteristics of baseball pitching motion in young pitchers. Sixty-five asymptomatic pitchers were analyzed with a motion capture system. The subjects were classified into two groups according to their age: A: 34cases (10-15 years old), B: 3lcases (19-34 years old). Kinematic and kinetic parameters were used to compare the differences between the two groups. Abduction and horizontal adduction angles of the upper arm were smaller in group A at ball release. The trunk was less flexed and twisted, but was bent much more toward the non-throwing side in the group A. There were no significant differences between the two groups with regard to the elbow angles, the wrist angles and the interval from arm-cocking phase to ball release. Our results showed that the young pitchers tend to put their pitch arm behind their trunk at ball release. That position is not close to “Zero Position”. It causes stretching the anterior structure of the shoulder. Furthermore, the shoulder is overloaded by the rotational stress from the end of armcocking phase to ball release. Repetition of this stress might cause epiphyseal damage for young pitchers. The young pitchers should be taught proper pitching mechanics. Limitation on pitches might be able to reduce the risk of epiphyseal damage in young pitchers.

著者

佐原 亮 遠藤 和博 五十嵐 絵美 浜田 純一郎 矢野 雄一郎

出版者

日本肩関節学会

雑誌

肩関節 (ISSN:09104461)

巻号頁・発行日

vol.38, no.3, pp.758-761, 2014

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肩疾患では屈曲と比べ外転しづらい.本研究の目的は屈曲と外転を比較することである.健常者11名22肩を対象とし,三次元動作解析を用い安静下垂位から屈曲・肩甲骨面挙上・外転し,上腕外旋角度,水平肩甲上腕角度,肩甲骨内旋角度を算出した.屈曲の上腕外旋角度は55&deg;であり直線的に増加し,外転では挙上初期から外旋角度が大きく100&deg;まで屈曲より多かった.屈曲では肩甲骨はまず内旋しその後外旋したが,外転は常に外旋した.水平肩甲上腕角度は外転で常に大きい.肩甲骨の外旋制限のある肩関節疾患では外転しづらい.屈曲では僧帽筋を弛緩し前鋸筋を収縮するが,外転では両筋を同時に収縮させる.棘下筋・小円筋も外転では筋長の短い状態での筋収縮が必要である.屈曲に対し外転は,(1)挙上初期から上腕外旋角度が大きく,(2)肩甲骨は常に外旋し,(3)水平肩甲上腕角度は常に大きい.

著者

宮島 玄陽 見目 智紀 中脇 充章 佐々木 秀一 大寺 亜由美 落合 信靖

出版者

日本肩関節学会

雑誌

肩関節 (ISSN:09104461)

巻号頁・発行日

vol.39, no.3, pp.619-622, 2015

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肩関節脱臼によって損傷した関節唇が外旋位によって整復されることは知られているが回旋による動態は未だ不明である.我々は手術を行った外傷性肩関節前方不安定症患者10名10肩について,損傷した関節唇の肩関節他動回旋時の動態をCine-MRIを用いて評価した.Cine-MRI上で関節唇が関節窩に圧着された肩関節下垂位での回旋角度(以下圧着角)と関節唇が関節窩から離開した回旋角度(以下離開角)を計測した.平均圧着角は15.7±24.6°,平均離解角は-1.1±20.9°であり,10肩中3肩は内旋域のみでも関節唇の関節窩への圧着がみられた.本研究より,関節唇は外旋により関節窩に圧着されても回旋角度が最大内旋に向かうに従い全例離開してしまうことが確認された.一方で内旋域のみでも角度により関節唇の関節窩への圧着が維持される例を30%認め,内旋位固定でも反復脱に移行しない症例が存在する一因と考えられた.

著者

石谷 栄一

出版者

日本肩関節学会

雑誌

肩関節 (ISSN:09104461)

巻号頁・発行日

vol.40, no.2, pp.611-614, 2016

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胸椎の矢状面アライメント並びにその可動性と外傷性・非外傷性腱板断裂の関連性を調査検討した.対象は入院患者128例で胸椎後弯角はスパイナルマウスを用いて,自然坐位,坐位屈曲,坐位伸展で計測した.また胸椎運動前後の運動効果も算出した.腱板断裂の有無は超音波検査を用いた.外傷群23例,非外傷群45例,正常群60例に分け各項目を3群間で多重比較検定をした.胸椎後弯角度は非外傷群が正常群に対して坐位と伸展で有意に大きく,可動域と運動効果が有意に小さかった.非外傷群は胸椎後弯が増大し,胸椎伸展可動域が低下し,胸椎運動の即時効果が得られなかった.胸椎後弯の増大と伸展可動域並びに運動効果の低下が非外傷群の断裂要因であることが示唆された.一方,外傷群と胸椎アライメント要因の有意な関係は認められなかった.

著者

大井 雄紀 高木 陽平 土山 耕南 乾 浩明 信原 克哉 吉矢 晋一

出版者

日本肩関節学会

雑誌

肩関節 (ISSN:09104461)

巻号頁・発行日

vol.40, no.2, pp.675-677, 2016

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Stride Foot Contact(SFC)における骨盤回旋,体幹と股関節の姿勢に注目し,年代別に運動学的検討をすることを目的とした.対象は野球投手287名:小学生(小)42名,中学生(中)94名,高校生(高)105名,コントロール群(コ)46名(19歳以上かつ球速120km/h以上)とした.対象者の投球動作をモーションキャプチャ・システムによりデジタル化した.大腿,腰部,体幹部に座標系を設定し,それぞれの座標系の回転をオイラー角で表した.全ての年代において,SFCの骨盤左回旋角度と相関関係がみられた変数は,それぞれ体幹左側屈角度(r = 0.5以上),右股関節内転角度(r = 0.49以上),右股関節伸展角度(r = 0.78以上),左股関節内転角度(r = 0.46以上),左股関節屈曲角度(r = 0.43以上)であった.骨盤が早期回旋しないよう体幹側屈,股関節屈曲伸展,内転に注目しながら投球指導を行う必要があると言える.

著者

小林 雅彦 水野 泰之 森 大祐 馬谷 直樹

出版者

日本肩関節学会

雑誌

肩関節 (ISSN:09104461)

巻号頁・発行日

vol.40, no.2, pp.513-517, 2016

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肩甲下筋腱(SSc)断裂の診断は困難なことが多い.我々はSSc断裂の診断精度を上げるため,MRI 上SScと肩甲骨(Sc)間に生じるT2 highの間隙である&ldquo;Gap sign(GS)&rdquo;に注目した.本研究の目的は,前向き研究によりGSのSSc断裂に対する診断精度について検討することである.<BR> 2014年にARCRを施行した42肩(平均年齢63.2&plusmn;10.2(SD)歳)を対象とした.単純MRI のoblique-saggital像において,scapular-Y viewから外側10mmにおいて,SScとSCの間に生じるT2強調像での高輝度領域をGSと定義した.術前にGS陽性か陰性か判定し,手術時にSSc断裂の有無を診断し,GSの精度を検定した.<BR> GS陽性24肩・GS陰性18肩で,SSc断裂ありが23肩,なしが19肩.感度91.7%・特異度94.4%・PPV 95.6%・NPV 89.5%であった.<BR> GSはSSc断裂を予測する優れた方法といえる.

著者

原田 幹生 高原 政利 村 成幸 丸山 真博 大石 隆太 宇野 智洋 佐竹 寛史 結城 一声 鶴田 大作 高木 理彰

出版者

日本肩関節学会

雑誌

肩関節 (ISSN:09104461)

巻号頁・発行日

vol.41, no.2, pp.564-568, 2017

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Lateral Scapular Slide Test(以下LSST)は,肩甲骨の位置を評価し,肩甲骨下角とその高さの脊柱との距離で示される.本研究の目的は,成長期の野球選手において,LSSTと関連する因子について検討することである.野球選手382名を対象とした(小学:185名,中学:133名,高校:64名).小中高の順序で,肩痛あり(26,29,44%),投球パフォーマンススコア(最悪0-100%最高)(80,79,70%)であった.LSSTは,小中高の順序で,投球側(7.8,8.5,9.5 cm),非投球側(7.8,8.4,9.3 cm),左右差(投球側と非投球側の差)(0.0,0.1,0.2 cm)であり,左右差が1 cm以上ある選手は(10,16,25%)であった.僧帽筋下部の筋力低下は,小中高の順序で,(23,58,45%)であった.LSST(左右差)は,中学生では関連する因子はなかったが,小学生では,投手,肩痛あり,および低い投球パフォーマンスと関連し,高校生では,投手と関連していた.LSST(左右差)は,小中高いずれにおいても,僧帽筋下部筋力と関連はなかった.

著者

原田 幹生 高木 理彰 村 成幸 丸山 真博 宇野 智洋 佐竹 寛史 鶴田 大作 結城 一声 大石 隆太 高原 政利

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.548-551, 2018

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関節内インピンジメント(インピンジ)は,投球動作の肩外旋時に,腱板と後上方関節唇が接触し,肩痛を生じる病態である.本研究の目的は,中学野球選手に生じるインピンジの頻度を調べ,後方タイトネス(タイトネス)とインピンジの関係を検討することである.中学野球選手154名を対象とした.投球側の肩痛(なし0点-最悪40点)の平均点は8.0点(1~36)であった.タイトネスは59名(38%)であった.fulcrumテストとrelocationテスト陽性をインピンジとすると,12名(8%)に認められた.平均の肩痛は,いずれもなし(n=87):2.3点,タイトネス単独(n=55):3.6点,インピンジ単独(n=8):9.1点,両者の合併(n=4):26.0点であり,タイトネスとインピンジの合併は,他の3群に比べ,有意に高かった(p<0.05).インピンジにタイトネスが合併すると,肩痛が有意に強くなっていた.タイトネスのため,インピンジによって加わる腱板への圧力がさらに増大し,肩痛が強くなったと推測された.