著者
肱岡 昭彦 鈴木 勝己 小林 靖幸 北條 暉幸 中島 民治
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.1, pp.9-12, 1991-09-01 (Released:2012-11-20)
参考文献数
10

Abnormal insertions of the pectoralis minor have been reported on by many authors, Most have dealt with its extending beyond the coracoid process and attaching itself to the capsule. We, however, studied the relationship between abnomal insertions of this muscle and the coracohumeral ligament.53 cadavers, i. e.106 shoulders were examined in this study,38 males and 15 females. The age of the cadavers ranged from 43 to 93, with mean age of 67.5 years.Abnomal insertions were found in 26 of the 53 cadavers and 39 of the 106 shoulders. This abnormality presented itself more often in females than in males.The coracohumeral ligament it usualy know as the ligament which occurs from the coracoid and is inserted in the humerus, but in our study this ligament did not clearly exist.In conclusion, we consider the coracohumeral ligament to be a residual l igament of the pectoralis minor or connective tissues in a part of the capsule.
著者
植木 博子 吉村 英哉 日山 鐘浩 望月 智之 二村 昭元 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.38, no.2, pp.369-371, 2014 (Released:2014-10-01)
参考文献数
7

小胸筋腱の停止が烏口突起をこえて延長する解剖学的破格は以前から知られている.過去に我々が調査した屍体解剖実習体では小胸筋延長腱の発現率は34.6%(81肩中21肩)であり,延長腱は烏口突起を越えて関節包の方に広がっていた.今回,肩腱板断裂症例において鏡視下修復術時に小胸筋延長腱の有無を確認し形態について観察した. 対象は2012年6月から12月までに当院で鏡視下腱板修復術を施行した腱板断裂症例25例(男性13例,女性12例)であった.術中にまず烏口突起基部を同定し小胸筋延長腱の存在を確認した. 延長腱は25例中10例(40%)に認められた.烏口突起に停止せずに上面を滑動し棘上筋の方向に向かい,烏口上腕靭帯とは明瞭に区別がついた. 臨床でも延長腱の発現頻度は比較的高く,その走行および付着の形態より肩甲上腕関節機能に影響を与えることが示唆された.鏡視下手術では延長腱の存在を留意する必要があると考えられた.
著者
森原 徹 小椋 明子 立入 久和 久保 俊一 黒川 正夫 三浦 雄一郎 福島 秀晃
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.715-718, 2011 (Released:2011-12-21)
参考文献数
8
被引用文献数
3

In the motion of shoulder flexion(0-90 degree), the scapula was upward rotated at the center of acromioclaviclular joint. In the abduction, the scapula was upward rotated and depressed with the clavicle elevation and retraction. The purpose of this study is to evaluate the muscle functions around the scapula by electromyographic analysis during the flexion and abduction of the shoulder. EMG activities of upper, middle, and inferior trapezius muscle, and serratus anterior, were examined in 5 static positions from 0 degrees to 150 degrees for 5 seconds in each position during exercises of shoulder flexion and abduction in 6 healthy volunteers. We used Telemyo System 2400(Noraxon USA Inc) and analyzed by MyoVideo and MyoResearch. The relative activity of upper trapezius muscle did not increase, and the muscle activity of serratus anterior was increased significantly during the early phase of flexion. The relative activity of upper, middle trapezius muscle has gradually increased during the early phase of abduction. The scapular upward rotation pattern was different between that in flexion and abduction. This study indicated that the symptom of accessory nerve palsy is disorder of abduction, and the main symptom of long thoracic nerve palsy is the inhibition of shoulder flexion.
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
日本肩関節学会
雑誌
肩関節 (ISSN:09104461)
巻号頁・発行日
vol.15, no.1, pp.13-17, 1991-09-01 (Released:2012-11-20)
参考文献数
11

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.1. The first stabilizing mechanismThis 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°.2. The second stabilizing mechanismThe second mechanism is the function of the anterior capsule including the inferior glenohumeral ligament.The anterior capsule works involuntary in both its tension and direction as the centripetal force does against the shear force.3. The disadvantages of these two stabilizing mechanismsThe 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- The decrease of bony structural intensity compared with other joints such as the hip joint.4. The third stabilizing mechanismThe third stabildzing mechanism is the function of the shoulder girdle.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.The second is the function of the shoulder girdle muscles such as the pectoralis major and the deltoid.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.
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 (Released:2008-01-30)
参考文献数
10

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
繁田 明義 内山 善康 橋本 紘行 持田 讓治 新福 栄治 大見 博子
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.907-910, 2011 (Released:2011-12-21)
参考文献数
16
被引用文献数
3

Many studies have reported treatment effects of H2 receptor antagonists (H2RA) on calcific tendinitis (CT) of the shoulder. The purpose of this retrospective study is to compare the clinical outcome between the cimetidine and the famotidine of CT of the shoulder. We studied 72 patients with CT of the shoulder who were closed with H2RA (cimetidine or famotidine) and loxoprofen sodium from 2005. They were treated as follows, 41 with cimetidine and loxoprofen (group C) (14 males, 27 females, average age 54.3 years old) 17 with famotidine and loxoprofen (group F) (10 males, 7 females, average age 58.4 years old) and 14 with loxoprofen(group N) (8 males, 6 females, average age 60.2 years old). Shoulder joint pain was assessed by using visual analogue scale (VAS), and the site and size of calcium deposits were calculated by X-rays (frontal view and scapula Y). In addition, influences of the complicating diseases (diabetes mellitus and hypertension) were evaluated for treatment effects. Groups C and F improved their pain and decreased calcium deposit size more than group N (p<0.05). However, the pain and calcium deposit size was not significantly different between group C and group F. Diabetic patients reduced the effectiveness more than non-diabetic patients in groups C and F. Hypertensive patients reduced the reduction ratio of calcium deposit more than non- hypertensive patients in groups C and F. There were the same clinical results for both cimetidine and famotidine for the CT of the shoulder. Diabetes mellitus and hypertension inhibited the treatment effects of H2RA.
著者
山口 久美子 加藤 敦夫 秋田 恵一 望月 智之
出版者
日本肩関節学会
雑誌
肩関節 = Shoulder joint (ISSN:09104461)
巻号頁・発行日
vol.34, no.3, pp.587-589, 2010-08-04
参考文献数
4
被引用文献数
1

Coracohumeral ligament (CHL) is situated in the gap between the supraspinatus and the subscapuralis. There are only a few studies concerning the CHL after Clark and Harryman II (1992) in spite of the important role that fills the rotator interval. In this study, we dissected six shoulders of three cadavers to observe the spatial distribution of the CHL in detail. Four shoulders of two cadavers were processed to analyze the attachment of the rotator cuff and the capsule histologically. For the histological analyses, whole parts of the CHL were removed emblock, and serial sections were made from proximal to distal. In gross anatomy, the CHL attached to the proximal lateral surface of the coracoid process in its most proximal part. It filled the rotator interval between the supraspinatus and the subscapularis. Most distal part of the CHL extended to both the superior and inferior surfaces of supraspinatus, and both the anterior and posterior surfaces of subscapularis. In the rotator interval, CHL connected to the superior glenohumeral ligament (SGHL). There was no clear border between the CHL and the SGHL in either gross anatomy or histologically. Histologically, the CHL contained only fine loose slack collagen fibers without any dense fiber that is normally observed in a ligament. With flexion and the extension, the CHL were stretched to pull the rotator interval. From these observations, the CHL seems to work with the SGHL for the stability of the long head of the biceps during shoulder movement.
著者
泉 仁 森澤 豊 村松 由崇 岩堀 裕介
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.399-403, 2018 (Released:2018-09-03)
参考文献数
14

上腕二頭筋長頭腱(以下長頭腱)は肩の疼痛源の一つであるが,長頭腱の痛みが肩肘の運動機能に及ぼす影響については不明な点が多い.本研究の目的は,長頭腱由来の痛みが肩外転・肘屈曲筋力に及ぼす影響を明らかにすることである.健常成人男性14人を対象とし,1mEq/mlの高張食塩水0.4mlを結節間溝内の長頭腱に注射して一時的な疼痛状態を作った.注射前後で肩外転・肘屈曲の等尺性最大収縮筋力を比較した.注射後の痛みVASの最大値は6.6[4.3-7.2]cm(中央値[四分位範囲])であった.肩外転筋力は注射前の71±5 %に,肘屈曲筋力は69±4 %に有意に低下した.構造的,生体力学的異常がないにもかかわらず,長頭腱由来の痛みは肩外転・肘屈曲筋力を約30%低下させた.本研究は長頭腱の痛みが肩肘の運動機能に及ぼす影響の重要性および痛みのために腱切除術や固定術を行うことの妥当性,有効性を示唆している.
著者
田中 直史 大沢 正秀 夫 猛 大槻 伸吾 大久保 衞
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.91-96, 1996-10-15 (Released:2012-11-20)
参考文献数
10

PURPOSEWe have reported that there are scapulo-humeral rhythms in the horizontal planes with flexion and extention of the shoulder joint as well as with the elevation of arms and decrease in movements of scapulo-thoracic joint by ageing. Now we wish to propose that there also exists a scapulo-humeral rhythm in the rotation of the shoulder.SU BJECTS AND METHODSWe measured the scapular inclination in seven normal volunteers ranged from 23 to 37(mean: 31), using an X-CT and setting it at a neutral position with the shouldes in abduction 0 ° and flexion 0° and the elbow in flexion 90 ° . The scapular inclinations were measured:1)from neutral to 30° and the maximal rotatio nal position (internal and external)2)at neutral and 30 ° rotation (internal and external) when maximal rota tion isotonic motion were performed.
著者
立入 久和 森原 徹 仲川 春彦 木田 圭重 祐成 毅 堀井 基行 久保 俊一 三浦 雄一郎 福島 秀晃 黒川 正夫
出版者
日本肩関節学会
雑誌
肩関節 (ISSN:09104461)
巻号頁・発行日
vol.35, no.3, pp.719-722, 2011 (Released:2011-12-21)
参考文献数
9
被引用文献数
3

Shrug exercise, which is one of the treatments for stiff shoulder and rotator cuff tear, is commonly performed. This exercise is also performed to relax the shoulder after surgery for rotator cuff repair. The effectiveness of shrug exercise for the rotator cuff has not been analyzed. The purpose of this study was to analyze the shrug exercise and to evaluate the usefulness of the shrug. Five asymptomatic male volunteers who had no history of shoulder abnormalities were examined. SSP (supraspinatus) muscle was measured by fine-wire electrodes and ISP (infraspinatus) muscle was measured by surface electrodes. At the time of non-shrug (group N) and shrug (group S), %MVC (maximal voluntary contraction) was calculated in the position of 0, 30, 60, 90 degrees flexion. %MVC of SSP in the position of 0,30,60,90 degrees flexion were 2,8,13,15% in group N, and 32,35,23,32% in group S. %MVC of SSP were increased at each angle. %MVC of ISP were 6,16,25,38% in group N, and 10,17,25,42% in group S. It has been reported that %MVC over 20% is high activity. %MVC of SSP showed over 20% at shrug position in this study, which was considered that shrug motion caused eccentric contraction of SSP muscle with the scapula elevating. From this study, it is considered that shrug excise is useful for cuff training, but may be overloaded on SSP in the early stage after surgery.
著者
加藤 真 岩堀 裕介 佐藤 啓二
出版者
日本肩関節学会
雑誌
肩関節 (ISSN:09104461)
巻号頁・発行日
vol.28, no.3, pp.481-484, 2004-08-30 (Released:2012-11-20)
参考文献数
9
被引用文献数
1

We verified the coaptaion effect of the subscapuraris muscle when the shoulder was immobilized the external rotation after initial anterior dislocation of the glenohumeral joint, and the practical use of the immobilizer to keep the shoulder in external rotation position. We evaluated twelve shoulders of the 12 patients with traumatic initial anterior dislocation of the shoulder. All of the patients were male, and the in mean age was 22.2 years old(range,17 to 30). Fast-spin-echo T2-weighted axial and sagittal magnetic resonance images were made, with the arm held at the side and positioned first in the maximum internal rotation and then in 15°external rotation within one week after the dislocation. We examined the coaptaion effect of the subscapuralis muscle comparing the images in the both positions. The patients were asked about the compliance and the discomfort of immobilization. Bankart lesions were identified in 11/12 shoulders (91.6%). The coaptaion effect was observed in 10/12shoulders (83.3%). All of the patients put on immobilizers for 3 weeks, and answered that discomfort was within the bounds of their torelance. Better coaptaion of a Bankart lesion was observed in external rotation compared with that in internal rotation. The immobilizer was of practical use.
著者
山本 敦史 高岸 憲二 岡邨 興一 設楽 仁 山口 蔵人 一ノ瀬 剛 小林 勉 大沢 敏久
出版者
日本肩関節学会
雑誌
肩関節 (ISSN:09104461)
巻号頁・発行日
vol.34, no.2, pp.471-474, 2010 (Released:2010-09-03)
参考文献数
9
被引用文献数
6

The purpose of this study was to investigate the influence of the variance of posture on shoulder pain and rotator cuff tears. A medical checkup was conducted for the residents of a mountain village in Gunma prefecture. The subjects consisted of 525 people including 1050 shoulders; 193 males including 386 shoulders and 332 females including 664 shoulders, with a mean age of 61.9 years old. We took their side view picture in a standing position, and divided them into 5 types according to the classification of Nakatani; normal (type 1), thoracic kyphosis (type 2), lumbar kyphosis (type 3), flat back (type 4), lumbar lordosis (type 5). We examined their background factors, physical examinations and ultrasonographic diagnosis of rotator cuff tear on both shoulders. We elucidated the prevalence of shoulder pain and rotator cuff tears with respect to each variance of posture. Additionally the subjects were divided into 2 groups; namely a Normal group (type 1), and a postural abnormality group (type 2-5). The differences between the 2 groups were evaluated.The normal type was present in 50.1%, thoracic kyphosis type in 24.6%, lumbar kyphosis type in 4.2%, flat back type in 6.7%, and lumbar lordosis type in 14.5%. Residents having shoulder pain frequently demonstrated thoracic kyphosis, flat back and lumbar lordosis. In addition, residents having rotator cuff tears frequently demonstrated thoracic kyphosis and lumbar kyphosis. The postural abnormality group was most commonly associated with elderly patients, who showed a decreased active forward elevation, a weaker external rotation strength, a positive finding for impingement sign and a decreased QOL. A logistic regression analysis revealed age, gender, present shoulder pain, an active forward elevation and EuroQOL (5 item) to all be significantly associated with an abnormality in the posture of these subjects.
著者
山口 光國 筒井 廣明
出版者
日本肩関節学会
雑誌
肩関節 (ISSN:09104461)
巻号頁・発行日
vol.33, no.3, pp.805-808, 2009 (Released:2010-01-29)
参考文献数
7
被引用文献数
6

We investigated the movement of the shoulder girdle which included the humerus position that athletes need to throw. We examined the movement of the shoulder girdle and relations with the state of the shoulder which we were aware of. The materials were 53 athletes to know their throwing movement. Their average age was 17 - 38 years old. (average 24.4±4.8) The results, the shoulder condition and the relations with the range of motion accepted middle-class correlation for the external rotation and internal rotation movement in the state of 90° flexion. The shoulder condition and the relations with the movement of the shoulder girdle accepted strong correlation in anterior, superior, inferior and the posterior recognized middle-class correlation. The result of this appraisal method did not accept significance between the pitching side and the un-pitching side. (p<0.01) The movement of the shoulder girdle on the basis of the humerus strongly influenced the condition of the shoulder of which we were aware of rather than the range of the shoulder motion. Although ROM was important as a medical treatment, it cannot be said that it was enough in respect of prevention of an obstacle. This evaluation method was important from a viewpoint of injury prevention to it. And this method was simple and we thought very easy to use.
著者
竹内 聡志 土屋 篤志 杉本 勝正 大藪 直子 後藤 英之 武長 徹也 鷹羽 慶之 大塚 隆信
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.495-498, 2016 (Released:2016-10-07)
参考文献数
9

原テストにおけるCombined abduction test(CAT)とHorizontal flexion test (HFT)と肩関節可動域の関係について調査を行った.2012年から2014年にメディカルチェックを行った大学生・社会人野球選手96名(平均年齢20.9歳,平均野球歴10.9年)を対象とした.全ての選手に原テスト11項目,肩可動域測定を施行した.その結果から,CAT・HFT共に陽性群(CH群),CAT陽性群(C群),HFT陽性群(H群),CAT・HFT共に陰性群(N群)に分類し,肩関節下垂位(1st),90°外転位(2nd)および90°屈曲位(3rd)における内外旋角度との関連を調査した.CH群49名,C群8名,H群8名,N群31名であった.CH群,C群,H群において非投球側と比較して投球側の2nd 内外旋総可動域(total arc)が有意に減少していたが,N群では有意差がなかった.投球側の2nd total arcは肩後方タイトネスの存在により,非投球側と比較して減少することが報告されている.この結果から,CAT・HFTは肩後方タイトネスの評価に有用である可能性が示された.
著者
松木 圭介 菅谷 啓之 前田 和彦 森石 丈二 望月 智之 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.213-215, 2007
被引用文献数
7

The purpose of this study was to examine the anatomy of the infraspinatus including the orientation of muscle fibers and the insertion to the greater tuberosity. Ninety-three shoulders from 52 cadavers were minutely dissected. After resection of the acromion and removal of the coracohumeral ligament, the infraspinatus muscle was carefully investigated macroscopically. After the orientation of muscle fibers was confirmed, the muscle was peeled from the proximal part to the distal part and the insertion of the infraspinatus tendon was examined. In 4 shoulders, muscle fibers were completely removed in water and the direction and insertion of the tendon were examined. The infraspinatus muscle originated both from the inferior surface of the spine of the scapula and the infraspinatus fossa, and inserted to the greater tuberosity. The muscle fibers originated from the spine were running dorsally and horizontally to the greater tuberosity. On the other hand, the fibers from the fossa were running ventrally and diagonally to the greater tuberosity. These fibers were merged at the insertion. The infraspinatus tendon had vast insertion to the greater tuberosity, and the most anterior part of the tendon was inserted to the most anterior portion of the greater tuberosity, bordering on the most anterior part of the supraspinatus tendon. The supraspinatus tendon is regarded as the most affected tendon in rotator cuff tears. However, the results of this study suggested that the infraspinatus tendon could be involved in the majority of rotator cuff tears. The infraspinatus may act not only in external rotation but also in abduction, because the infraspinatus tendon was inserted to the most anterior part of the greater tuberosity.
著者
美舩 美舩 乾 淳幸 坂田 亮介 原田 義文 高瀬 史明 植田 安洋 片岡 武史 国分 毅
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.476-480, 2016

加齢に伴う腱板組織へのadvanced glycation end products(AGEs)沈着量の変化と力学的強度の変化を,SDラットを用いて検討した.3,6,12,24か月齢のSDラットの棘上筋腱を用いて組織学的検討を行い,力学的評価として棘下筋-上腕骨複合体の最大破断強度を引っ張り試験にて評価した.HE染色では12,24か月齢のラット腱板において細胞浸潤,コラーゲン線維配列の乱れを認めた.免疫染色では加齢に伴ってAGEs沈着の増加を認め,またAGE受容体の発現増加も認めた.TUNEL染色でも同様に加齢に伴うアポトーシスの増加を認め,力学的試験では12,24か月齢において破断強度の低下を認めた.我々はこれまでにin vitro実験において,AGEsが腱板由来細胞のReactive Oxygen Species発現を増加させ,アポトーシスを増加させることを明らかにしてきた.本研究より,肩腱板においてもAGEsの沈着が細胞障害性を持つ一方で,力学的な脆弱性と相関しており,AGEsの増加が加齢に伴う腱板断裂の一因になっていることが考えられた.
著者
吉村 英哉 望月 智之 秋田 恵一 加藤 敦夫 山口 久美子 新井 隆三 菅谷 啓之 浜田 純一郎
出版者
日本肩関節学会
雑誌
肩関節 (ISSN:09104461)
巻号頁・発行日
vol.35, no.3, pp.707-710, 2011 (Released:2011-12-21)
参考文献数
18
被引用文献数
1

Our previous study revealed that the most proximal portion of the subscapularis tendon extended a thin tendinous slip to the fovea capitis of the humerus, and that the coracohumeral ligament (CHL) together with the SGHL was shaped like a spiral sling, supporting the long head of biceps and attached to the tendinous slip. Little information is available, however, regarding the relationship between CHL and the insertion of subscapularis on the lesser tuberosity. To clarify the significance of CHL, we examined the morphology of CHL and the subscapularis insertion in 20 cadaveric shoulders. The anterior portion of CHL arises from the base of the coracoid process and fans out laterally and inferiorly on the subscapularis. The fibers envelop the tendinous portion of the subscapularis on either side. As a result, the ligament forms a cable-like anterior leading edge over the rotator interval. The subscapularis tendon can appear in relative anatomic position unless the arm is brought into internal rotation and relaxation is achieved. We also demonstrated that CHL was associated with opening the bicipital sheath along its medial border during shoulder elevation. The coracohumeral ligament might contribute to the stability of the subscapularis tendon and to the morphology of the bicipital groove.
著者
植木 博子 吉村 英哉 日山 鐘浩 望月 智之 二村 昭元 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.38, no.2, pp.369-371, 2014

小胸筋腱の停止が烏口突起をこえて延長する解剖学的破格は以前から知られている.過去に我々が調査した屍体解剖実習体では小胸筋延長腱の発現率は34.6%(81肩中21肩)であり,延長腱は烏口突起を越えて関節包の方に広がっていた.今回,肩腱板断裂症例において鏡視下修復術時に小胸筋延長腱の有無を確認し形態について観察した.<BR> 対象は2012年6月から12月までに当院で鏡視下腱板修復術を施行した腱板断裂症例25例(男性13例,女性12例)であった.術中にまず烏口突起基部を同定し小胸筋延長腱の存在を確認した.<BR> 延長腱は25例中10例(40%)に認められた.烏口突起に停止せずに上面を滑動し棘上筋の方向に向かい,烏口上腕靭帯とは明瞭に区別がついた.<BR> 臨床でも延長腱の発現頻度は比較的高く,その走行および付着の形態より肩甲上腕関節機能に影響を与えることが示唆された.鏡視下手術では延長腱の存在を留意する必要があると考えられた.
著者
森澤 豊 野口 政隆 川上 照彦 山本 博司 貞廣 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.22, no.2, pp.267-269, 1998-06-25 (Released:2012-11-20)
参考文献数
3
被引用文献数
1

We studied the mechanism of musculocutaneous neuropathy associated with the Boytchev procedure in cadavers.(Materials and methods)The subjects we re 21 adult cadavers (42 shoulders) for anatomical study. The distance from the anterior end of the coracoid process to the site of the entry of the musculocutaneous nerve trunk into the coracobrachialis muscle was determined as A, the distance to the insertion of the short head of the biceps among the nerve branches as B, and the distance to the coracobrachialis insertion site as C. Then, the coracoid process (served to measure the insertion of the short head of the biceps and that of the coracobrachialis) was returned to its original position beneath the full-thickness of the subscapularis muscle by the original Boytchev method, and the distance from the anterior end of the coracoid process to the lower margin of the subscapularis was determined as D.(Results)A was 47.5±13.2mm, B was 30.1±6.2mm, C was 33.9±7.5mm and D was 33.3±5.3mm. A was below D, i. e., the entry site of the musculocutaneous nerve trunk was above the lower margin of the subscapularis muscle, and entrapment of the musculocutaneous nerve trunk by the subscapularis muscle was present in nine shoulders (21.4%).(Discussion)In patients where the site of the entry of the musculocutaneous nerve trunk into the coracobrachialis muscle is at a higer position than the lower margin of the subscapularis, it appears necessary to take technical precautions such as passing the severed coracoid process through the lower one third of the belly of the subscapularis.
著者
林田 賢治 田中 誠人 小泉 宏太
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.853-856, 2011 (Released:2011-12-21)
参考文献数
4
被引用文献数
1

The clinical result of arthroscopic triple row suture anchor repair (combined operation of double anchor footprint fixation and single row method) for complete rotator cuff tear is reported in the present study. Twenty-two shoulders (the average age at operation was 69 years old: range 53-78) were involved and followed for more than 6 months (average follow up: 10 months). The clinical results were evaluated with JOA shoulder score and post operative cuff integrity was assessed by MRI and classified with Sugaya's classification. The pre-operative average JOA score, which was 71.5, improved to 92.1 at follow up. Regarding post operative cuff integrity, complete repair (type 1 and 2) was seen in 13 shoulders (59%), repaired with thin tendon (type 3) was seen in 2 shoulders (9%), re-tear (type 4 and 5) was seen in 7 shoulders (32%). In re-tear cases, 6 of 7 were type 4, and type 5 was seen in only 1 case. Comparing this to our previous data of repair integrity of double row suture anchor method, type 4 increased and type 5 decreased. Cutting out tendon by tight bridging sutures could be the cause of increasing type 4, and tension adjustment of bridging sutures could be important to prevent tendon cut out.