著者

武長 徹也 竹内 聡志 後藤 英之 吉田 雅人 西森 康浩 大塚 隆信 杉本 勝正 大藪 直子 土屋 篤志 多和田 兼章

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.1121-1123, 2009

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<B>Background:</B> The purpose of the present study was to evaluate the clinical results of conservative treatment for rotator cuff tears.<BR><B>Methods:</B> 33 shoulders of 28 patients were evaluated and diagnosed as having rotator cuff tear with magnetic resonance image or ultrasonography in our institution. There were 13 male cases (17 shoulders), and 15 female cases (16 shoulders). The average age of the 33 shoulders at the time of the diagnosis was 70.9 years old (range 56 to 82 years) and their mean follow-up period was 37.5 months (range 12 to 106 months). With respect to tear size, 4 shoulders were categorized as massive tears, 5 were large tears, 14 were medium tears, 9 were small tears. There was 1 partial tear at the bursal side. The clinical results were evaluated by Japanese Orthopaedic Association shoulder scoring system (JOA score) and pre and post therapeutic active range of motion was also investigated.<BR><B>Results:</B> The average JOA score improved from 69.2 points at first exam to 84.0 points at the final follow-up. However, younger patients (less than 60 years old) showed deterioration. Improvement of active range of motion has been confirmed from 139 to 156 degrees in elevation, from 135 to 150 degrees in abduction, from 57 to 63 degrees in external rotation and from L2 to L1 level in internal rotation at the final follow up.<BR><B>Conclusion:</B> In most of the cases, clinical results of conservative treatment for rotator cuff tears were satisfactory except for younger and active patients.

著者

舟崎 裕記 吉田 衛 戸野塚 久紘 加藤 壮紀 加藤 基樹 丸毛 啓史

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.2, pp.459-462, 2015

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40歳以上のスポーツ愛好家における腱板全層断裂に対して保存的治療を行った結果,症状が改善した35例,37肩のスポーツ評価法を含めた成績を検討した.断裂サイズは小8肩,中19肩,大6肩,広範囲4肩で,スポーツ種目は,ゴルフ13例,テニス5例,水泳3例,ダンス系3例などであった.平均観察期間は28カ月であった.初診時JOAスコアは平均67点で,いずれの症例もスポーツ活動を休止していた.最終観察時では平均91点となり,とくに疼痛の著明な改善が得られていた.全例が元の競技に復帰し,32例は現状のスポーツ活動に80%以上満足していたが,JSS-SSSは平均84点で,大,広範囲断裂のもの,筋力低下が残存したもの,テニスなどのオーバーヘッド競技者ではJSS-SSSは低かった.保存的治療により症状の改善が得られた症例ではスポーツ活動に対する満足度も比較的高かったが,そのスポーツ能力には,断裂サイズ,筋力,競技種目が関与していた.

著者

三森 甲宇 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.37, no.2, pp.821-823, 2013 (Released:2014-04-03)

参考文献数

9

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Background: We reported that transverse cervical artery had various forms in the cadaver. The purpose of this study was to examine patients with neck and shoulder pain from vascular resistance of the transverse cervical artery.Methods: The subjects consisted of 54 patients with neck and shoulder pain (group P) and 20 normal volunteers (group N). They were all females, and their mean age was 67.2 in group P and 70.4 in group N.Firstly isometric exercise around the neck and back was performed on all subjects in the sitting position. Patients were only asked whether the pain had changed before and after exercise. The transverse cervical artery was identified by color doppler ultrasonography, and pulsatility index (PI) was measured by pulsed doppler imaging. PI was compared between group P and group N, and was compared with the effects of exercise in group P.Results: After exercise, the pain was the same in 16 patients, improved partially in 27 patients and disappeared in 11 patients. PI of the deep branch in the group P was significantly larger than that in group N. PI of the deep branch in the 11 patients whose pain disappeared, tended to be smaller than that of the other patients.Conclusion: We suppose that high vascular resistance of the deep branch of the transverse cervical artery is a characteristic seen widely in patients with neck and shoulder pain.

著者

多和田 兼章 竹内 聡志 鷹羽 慶之 後藤 英之 武長 徹也 大塚 隆信 杉本 勝正 大藪 直子 土屋 篤志

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.795-797, 2014 (Released:2014-11-21)

参考文献数

9

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今回の研究の目的は当院における肩関節脱臼に対するStimson法の整復率について調査することである.当院救急外来にて研修医がStimson法で整復を行った肩関節前方脱臼21例22肩(平均年令60.8歳,男性13例,女性8例)を対象とした.外傷性脱臼が14肩,反復性脱臼が8肩であった.整復できた群をStimson法群,Stimson法で整復できなかった群をFailure群とし,比較を行った.当院におけるStimson法の整復率は40.9%(9/22肩)であった.他の13肩はzero position法で整復された.Failure群13肩では年齢が高く,合併損傷を伴う外傷性脱臼が多い傾向にあった.Stimson法は簡便で,非侵襲的だが,整復時間を要することや低い整復率が問題である.当施設においても40.9%と他の整復法と比較して低い整復率であった.

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 (Released:2016-10-07)

参考文献数

13

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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

伊藤 岳史 岩堀 裕介 筒井 求 梶田 幸宏 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.41, no.2, pp.598-601, 2017

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16歳女性,ハンドボール選手.ハンドボール中に右肩水平外転肢位を強制され,右肩関節が亜脱臼した.その後,右肩脱臼不安感が持続するため当科受診した.外傷性肩関節前方不安定症と診断し,Bankart損傷とSLAP損傷および関節上腕靭帯上腕骨側剥離(HAGL)損傷の鏡視下修復術を行った.術後に腋窩神経固有支配領域の知覚低下と三角筋麻痺を確認し,針筋電図検査にて三角筋に脱神経電位を認めたため,術後3か月時に腋窩神経剥離術を行った.HAGL修復に用いた縫合糸が腋窩神経を貫通し結紮していた.糸を除去した上で神経剥離術を行った.神経症状は良好に改善し,再手術後6か月でハンドボールに完全復帰した.HAGL損傷の鏡視下修復術の際には腋窩神経損傷の危険性を念頭に置いて慎重に行う必要がある.

著者

武長 徹也 堀内 行雄 伊藤 恵康 古島 弘三 草野 寛 船越 忠直 古賀 龍二 山本 譲 宮本 梓 井上 彰 村山 俊樹

出版者

日本肩関節学会

雑誌

肩関節 (ISSN:09104461)

巻号頁・発行日

vol.43, no.2, pp.584-588, 2019

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18歳以下の若年で胸郭出口症候群(TOS)に対し手術を要したオーバーヘッドスポーツ選手の特徴を明らかにするため調査を行った.TOSに対して手術を施行したオーバーヘッドスポーツ選手110例119肢を対象とし,手術時年齢で18歳以下群と19歳以上群に分け,術前臨床症状,画像所見,術中所見などを比較した.18歳以下群は82例89肢(平均15.8歳,男性78例,女性4例,野球75例),19歳以上群は28例30肢(平均20.6歳,男性26例,女性2例,野球26例)であった.臨床症状の各項目に有意差は認めず,18歳以下群の特徴として①前中斜角筋間距離が狭い,②肩関節90度外転外旋位で腋窩動脈2nd partの血流が遮断される選手の割合が高い,③挙上位血管造影3DCTによる鎖骨下動脈の圧迫所見陽性率が高いことが明らかとなった.静的,動的に肋鎖間隙が狭い選手ほど,オーバーヘッドスポーツキャリアの早期でTOSを発症し競技継続困難となり手術を要すると考えられた.

著者

山鹿 眞紀夫 高木 克公 森沢 佳三 井手 淳二 生田 拓也 北川 敏夫 鬼木 泰博 山隈 維昭

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.2, pp.129-133, 1988-08-10 (Released:2012-11-20)

参考文献数

6

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Neurovascular compression in the thoracic outlet produces great variation of signs and symptoms. The clinical picture is often complex, being made up of the derangement of blood vessels, somatic nerves and autonomic nervous networks in varying degrees. Thirty-eight of the 150 patients (25%) treated in our clinic because of possible thoracic outlet syndrome (TOS), complained of general malaise such as headache, dizziness, sleeplessness, nausea, anorexia or general fatigue, in addition to their peculiar signs and symptoms due to brachial plexus involvement.In order to find out whether or not autonomic nerve dysfunction can be demonstrated in patients with TOS, a non-invasive and quantitative technique was developed for assessing the mean (M) and coefficient of variations (CV) of R-R intervals in ECG at resting position. Thirty patients (13-39; mean 29.5 y/o) were put into two groups of 15 patient s each. In the first group patients with autonomic nerve disorder had complaints of general discomfort, M was 803.72 ± 106.9 msec and CV was 3.214±0.717%. In the second group, those without general discomfort, M was 972.21 ± 120.64 msec and CV was 5.926±0.720%. The first group had a significantly shorter M (P < 0.001) and smaller CV (P < 0.001) compared to the second group. Furthermore, in two cases in the first group diagnosed by psychologists as having schizophrenia and anxiety neurosis, it was found that their M and CV were the nearly same as those in the second group.Decompressive ope r a tions were performed on five patients in the first group. Their complaints decreased or vanished after the operation and the M and CV progressed to near the normal rate.From these results, we belive that this method in useful in differentiating between autonomic nervous disorders and psychological disorders; and that in patients with TOS, a decompressive operation can help eliminate complaints of general discomfort due to autonomic nervous disorders.

著者

仲川 喜之 梅垣 修三 尾崎 二郎 富田 恭治 中垣 公男 桜井 悟良 松倉 光晴 建道 寿教

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.110-115, 1994-09-01 (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 report is to evaluate the results of treatment for fractures of the scapula with associated injuries. This study was composed of 123 patients (130 fractures). One hundred and seven were males and 16 were fenales. Their average age was 44.8 ranging from 3 to 84. The fractures were divided into four types as follows; scapular body: 54 cases, scapular neck: 40 cases, coracoid process: 18 cases, acromion or scapular spine: 18 cases. Seven cases had fractures in more than one location. Eighty-one of the 123 cases (66%) had assoceated injuries. Ninety-four cases were treated conservatively and 29 cases surgically. The results of the treatment were evaluated by the J.O.A.score.The results of cases without any nerve injuries were judged as excellent (mean score of conservative cases: 92.3 points, surgical cases: 97.1 poinys). Cases with nerve injuries had poor results (mean score of the conservative cases: 80.3 points, surgical cases: 85.7 points).An association between scapular fractures and fractures of the ribs is common. In those cases, a pneumothorax may not develop immediately after a traumatic episide, but it may occur after a few days. An acromioclavicular dislocation is apt to be associated with a fracture of the coracoid process, in which case, surgical treatment is indicated. A displaced fracture of the scapular neck associated with a clavicular fracture on the same side is unstable, in which case, surgical treatment is indicated. A rotator cuff tear is apt to be associated with a fracture of the scapular body or but it is often overlooked, Associated nerve injuries have a great inflvence on the results. It is important to examine an associated nerve imjury and to start rehabilitation as soon as possible. neck, very

著者

西中 直也 近 良明 Banks Scott A 三原 研一 鈴木 一秀 大田 勝弘 牧内 大輔 松久 孝行 筒井 廣明 杉本 英治 蒲田 和芳

出版者

日本肩関節学会

雑誌

肩関節 (ISSN:09104461)

巻号頁・発行日

vol.32, no.3, pp.509-512, 2008 (Released:2008-11-21)

参考文献数

16

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The glenoid bare spot commonly is observed in the adult shoulder. Carter et al. proposed that cartilage thickness was affected by normal homeostatic loads. The purpose of this study was to measure glenohumeral translation during shoulder abduction in order to explore development of the glenoid bare spot. 10 healthy shoulders (average 31.1 years old) were studied. 3D models of the scapula and humerus were created from CT scans. Motions were recorded with fluoroscopy during active abduction in neutral rotation for unloaded and a 3kg loaded trial. 3D motions were determined using model-based 3D-to-2D registration. Humeral translation was referenced in the superior/inferior direction to the assumed location of the bare spot (center of the circle described by the bony margins of the inferior glenoid). The bare spot location averaged 4.3mm inferior to the superior/inferior midpoint of the glenoid. Glenohumeral contact was 2.6 and 3.1mm superior to the bare spot for unloaded and loaded conditions with the arm at the side. The humeral head moved upward gradually with abduction to 4mm above the bare spot above 70° abduction (p>0.05, 0 vs 3kg). The glenoid surface stabilizes humeral head translation. Carter et al. suggested that cartilage grew thickest with high mechanical demands (compression and sliding) and thinner where demands were low. Humeral translation away from the bare spot with abduction suggests that lower loads were experienced when the humeral head was near the bare spot and larger loads were experienced with humeral translation away from the bare spot. These kinematic observations were consistent with Carter's framework for cartilage growth and provided a plausible explanation for the development of the glenoid bare spot.

著者

廣瀬 聰明 野中 伸介 上野 栄和 木村 重治 吉本 正太 道家 孝幸 杉 憲 岡村 健司

出版者

日本肩関節学会

雑誌

肩関節 (ISSN:09104461)

巻号頁・発行日

vol.35, no.3, pp.883-887, 2011 (Released:2011-12-21)

参考文献数

12

被引用文献数

4

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We performed arthroscopic rotator cuff repair (ARCR) for all rotator cuff tears. The purpose of this study was to evaluate the clinical results of ARCR using double-row technique. We retrospectively studied 64 patients (65 shoulders) who had received ARCR using double-row technique and who were followed up for more than 2 years. The patients were 30 males and 35 females. The mean age at operation was 65 years old (range, 44-86). The mean postoperative follow-up period was 25 months (range, 24-36). The clinical results were assessed using JOA scores and MRI by Sugaya's classification. Tear size was small tear in 9 shoulders, medium in 36, large in 12, and massive in 8. The mean JOA total score was significantly improved from 66 points preoperatively to 96 points postoperatively. Postoperative MRIs showed 20% re-torn cuff in all cases, especially, 40% in large and massive tears. In 45 shoulders which had MRI taken regularly, re-tear by MRI was revealed within 3weeks: none, at 3 months: 4 shoulders, at 6 months: 1shoulder, at 1 year: 4 shoulders, and 2 years: none. In this study, the clinical results of ARCR using double-row technique was mostly satisfactory. But JOA score in no tear group (97points) was better than re-tear group (92points). So we have to consider the methods to prevent re-tear after ARCR.

著者

中川 滋人 小室 透 福島 直 小畠 昌規 宮崎 義雄 米田 稔

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.567-570, 2003-10-30 (Released:2012-11-20)

参考文献数

11

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The purpose was to investigate the efficacy of several diagnostic methods to detect superior labrum injuries in throwing shoulder. Fifty-four throwing athletes, who underwent arthroscopic surgery, were prospectively studied. There were superior labrum injuries in twenty-four cases and loose attachment of the superior labrum in six. The efficacy of preoperative diagnostic methods were investigated comparing them with arthroscopic findings of superior labrum injuries. The forced shoulder abduction and elbow flexion test (forced abduction test) was diagnosed as positive, when pain at the postero-superior aspect of the shoulder in forced maximal abduction was reduced or diminished in elbow flexion. The most useful test to detect superior labrum injuries was the forced abduction test, and the sensitivity, specificity, and accuracy was 73%,69%, and 70%, respectively. Loose attachment of the superior labrum significantly increased false positive rate of this method. Forced abduction tests were simple and effective for diagnosis of superior labrum injuries in throwing shoulders.

著者

中野 幸雄 日比野 仁子 杉本 勝正

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.235-239, 2001-08-02 (Released:2012-11-20)

参考文献数

5

被引用文献数

1

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[Purpose]The coracohumeral(CH)ligament is deeply related to the restriction of lateral rotation of the shoulder joint. The present report concerns our experience in evaluation of the CH ligament by 3D MRI in relation to the restriction of a lateral rotation.[Materials and methods]The study covered 43 shoulders of 43 patients who had disorders in the shoulder since 1999, and underwent 3D MRI examination. Of these subjects, llshoulders of llpatients were examined twice, when the symptom was distinct and at a stage of remission. As controls,9shoulders of 8 healthy persons were observed. The MRI equipment used was Model SIGNA HORIZON LX 1. OT of GE Yokokawa Medical, and images were constructed on the basis of 3D GRASS images (TR 32, TE 15) derived from 100 consecutive slices of 1mm thickness. The correlation of the angle of lateral rotation as measured at the time of MRI examination with the thickness, length and signal intensity of CH ligament determined on MRI image was checked.[Results]The mean values of lateral rotational angle, and thickness of CH ligament were 71.1°and 3.1mm, respectively, in the normal group(N), while those in the symptomatic group(S)were 35.6°and 5.2mm. A significant correlation was recognized between the lateral rotation angle and the thickness of the CH ligament. No significant correlation was seen between the lateral rotation angle, signal intensity and ligament length. in group S2 where the MRI examination was carried out twice, at the symptomatic phase and at the remission phase, the lateral rotation angle increased and the thickness of the CH ligament reduced significantly in the remission phase in comparison to those in the symptomatic phase.[Conclusion]The more the lateral rotation was restricted, the greater the thickness of the CH ligament was. This study indicates that the movable range of the shoulder joint can be estimated on the basis of image diagnosis.

著者

土屋 篤志 大藪 直子 後藤 英之 堀内 統 吉田 雅人 西森 康浩 大塚 隆信 武長 徹也 杉本 勝正

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.2, pp.567-569, 2011

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We investigated the shoulder function of the frozen shoulder after an average of thirty months (12 to 108 months) of the conservative treatment. In this study, 17 shoulders of 16 patients (13 males and 3 females) of non-traumatic frozen shoulder without rotator cuff tear were investigated. The mean age of all cases was 66 years old, ranging from 47 to 76 years old. At an average of 30 months follow-up, the clinical results and shoulder function including subjective and objective evaluation, range of motion and shoulder strength using micro FET, were investigated. The mean JOA score was 63.7 points at the initial treatment and 82.5 points at the end of the treatment. After thirty months of the treatment, JOA score was improved to 93.4 points. About 88% of the patients were satisfied with their daily living, although 16.7% of the patients changed sports activity level or their work. Seven of 17 patients who were satisfied with their ADL, restricted some concrete action related to shoulder function such as scratching their back. The range of motion of flexion, abduction and external rotation of the affected side tended to be lower compared with the normal side, but not significantly. The strength of the shoulder of the affected side was improved without a significant difference from normal side. The prognosis of the frozen shoulder was relatively good with a little discomfort for living and a limitation of sports activity.

著者

冨岡 立 皆川 洋至 木島 泰明 山本 宣幸 阿部 秀一 菊池 一馬 島田 洋一

出版者

日本肩関節学会

雑誌

肩関節 (ISSN:09104461)

巻号頁・発行日

vol.32, no.2, pp.225-228, 2008 (Released:2008-08-30)

参考文献数

13

被引用文献数

1

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Structural changes of rotator cuff muscle after torn rotator cuff tendon are the muscle atrophy, the shortening of muscle fiber length, and fatty infiltration. However, there is no report about the sarcomere length which is one of the factors related to the contractile ability of muscle. The purpose of this study was to clarify the sarcomere length of torn rotator cuff muscle. 14 embalmed cadaver shoulders were enrolled in this study. The average age was 82 years old (range: 74-91). There were 7 full-thickness rotator cuff tear shoulders and 7 normal shoulders. Muscle fiber length was measured using a digital caliper. Sarcomere length of the rotator cuff muscle was determined by laser diffraction.In the cuff tear group, muscle fiber length of the supraspinatus: SSP, infraspinatus: ISP, teres minor: TM, and subscapularis: SSC was 33.2±6.3mm, 70.6±9.9mm, 57.4±6.4mm, and 58.2±9.6mm, respectively. In the normal cuff group, that of SSP, ISP, TM, and SSC was 57.3±13.7mm, 73.4±14.0mm, 58.2±11.2mm, and 57.8±11.7mm, respectively. The muscle fiber length of SSP in the cuff tear group was significantly shorter than that of SSP in the normal cuff group (P=0.0157). ISP, TM, and SSC showed no significant difference in the muscle fiber length. In the cuff tear group, the sarcomere length of SSP, ISP, TM, and SSC were 3.07±0.41μm, 3.16±0.42μm, 2.80±0.27μm, and 2.41±0.21μm, respectively. In the normal cuff group, those of SSP, ISP, TM, and SSC were 3.18±0.46μm, 3.21±0.57μm, 3.13±0.34μm, and 2.60±0.22μm, respectively. There was no significant difference in the sarcomere length. Although the muscle fiber length of SSP with rotator cuff tear was significantly shorter than that of SSP without rotator cuff tear, the sarcomere length of SSP had no significant difference between the cuff tear group and the intact cuff group. These results indicate that the number of sarcomere may reduce to adapt the shortened muscle fiber length of supraspinatus to maintain muscle contractile ability.

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.